How is EDF/Mehta Casting Different for Early Onset Progressive Infantile Scoliosis & Early Onset Congenital Scoliosis?

Imagine there are two different families, one family is told their 10 month old baby has a 35 degree idiopathic curve, an early onset progressive scoliosis diagnosis and then the other family is told their 10 month old baby also has a 35 degree congenital scoliosis curve from an abnormally shaped vertebrae.  I often see parents early on thinking, “ok sure they are different but they can’t be that different a curve is a curve and the treatments must be similar.”  This sentiment couldn’t be further from the truth really.

Let’s talk about the differences

 

Early Onset Progressive Infantile Scoliosis – Idiopathic

 

Early Onset Congenital Scoliosis
Onset happens anywhere from birth to age 3
Idiopathic means the cause is unknown
Occurs during fetal development causing abnormally shaped vertebrae to develop.

Curve onset or progression occurs between birth and age 10

Often has the potential of being corrected with non-invasive treatment Can only be corrected through surgery.
It’s usually best to treat this as early and as young as possible. Waiting and watching is usually the first form of treatment
Non-invasive treatment like EDF/Mehta Casting has its best opportunity for success in correcting a curve when casting begins as early as possible EDF/Mehta casting is not recommended for all CS cases.  In cases where it is recommended it’s usually not started as young as possible or with lower curve degrees.  Casting in congenital usually doesn’t happen till a curve is showing signs of rapid progression in the wait and watch stage and it’s often not done till a curve is higher in degree closer to the 50 degree mark.  It’s also usually not started in kids over the age of 2 and half to three. If a child has made it to that age and the curve has only just hit a higher degree casting usually doesn’t make sense
EDF/Mehta casting CAN correct a curve of this type. How much it corrects varies from each child and case.  The goal is to try and get under 15 degrees. EDF/Mehta casting can NOT correct this type of curve.
EDF/Mehta Casting will not correct all curves to under 15 degrees.  But casting is still considered successful if it can slow down the progression and allow a child to grow  and for his/her lungs and heart to develop more before surgery is needed EDF/Mehta casting will only correct a curve while in the cast.  Once the cast is off the curve will go back.  Casting is considered successful when it slows down the progression of the curve and allows a child to grow and his/her lungs and heart to develop more before surgery.

 

EDF/Mehta casting is an incredible non-invasive treatment option for early onset scoliosis. It should almost always be considered a first line of defense that is started early for idiopathic cases.  In congenital cases waiting and watching is usually best.  Waiting and watching can be very hard for parents, especially if they are talking to their early onset progressive idiopathic scoliosis counterparts who are treating as soon as possible.  Because congenital scoliosis can only be ‘fixed’ surgically you do not want to intervene even with casting too early because it’s not going to fix it, it’s only going to slow the progression down, so there’s no need to put a child through the casting process early, they are already likely going to be going through surgery or surgeries later.  And yes, casting isn’t going to fix all idiopathic cases either but it it the goal and in cases where it isn’t going to fix it, it’s a vital tool to buy growth time before these kids face surgery too.

It’s also important to remember, there are still many types of congenital scoliosis where casting is not going to be good option for a number of different reasons.  But I will add, casting for congenital cases as a whole is rather new.  It’s really only been done in the last seven years or so.  So there are many pediatric spine surgeons who specialize in congenial scoliosis but do not cast or even recommend it in cases where it might make sense.  This is starting to change but fast enough.  There are studies out showing its effectiveness to slow down the progression of a curve and buy valuable growth time for many CS children.

At the end of the day, families should often get more than one opinion on treatment plans and I believe that should always include a surgeon who provides EDF/Mehta casting when you have any type of Early Onset Scoliosis diagnosis.  If you want to buy a home in Southern Florida are you going to choose a realtor who has lived their entire life in Alaska and has been a commercial realtor there or are you going to choose someone familiar with the southern Florida market and residential real estate? Same thing.

If you have any other questions or thoughts on the differences, please comment below.

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