Serial cast vs brace for delaying surgery in congenital scoliosis

English Keywords:Congenital scoliosis  Serial cast  Brace  Delay first-operation  Children

English Abstract:

  【Abstract】 Objectives: To compare the outcomes of serial cast and brace in congenital scoliosis. Methods: A total of 24 congenital scoliosis was reviewed, 13 males and 11 females. The average age at first cast was 2.9±1.2 years old(1.3-5.4 years old). There were 12 cases treated with serial casting, while 12 cases with brace. Several parameters including Cobb angle, thoracic kyphosis angle, lumbar lodosis angle, growing rate of thoracic spine, surgery delaying time were evaluated. Results: In cast group, the follow-up period was 29.2±14.3(16－56) months. The average cast wearing time was 18.5±3.7(13－23) months; the Cobb angle decreased from 56.2°±20.5°(30.1°－89.4°) at pre-casting to 48.8°±18°(22.3°－78°) at final follow-up (Ｐ<0.01) with correction rate of 13.2%; the growth rate of thoracic spine was 0.78±0.16cm/year(0.62-0.91cm/year). At final follow-up, 4 cases continued serial cast procedures, 6 cases removed the cast and wore brace, 2 cases received operation. The surgery was delayed for 28.8±14.3 months. In brace group, the follow-up period was 26.7±12.5(15－46) months, the Cobb angle increased from 44.2°±16.4°(25.4°－62.6°) at pre-brace to 55.6°±16.7°(34.8°－68.8°) at final follow-up(Ｐ<0.01),　with a lower correction rate when compared with cast group(-21.3%,　Ｐ<0.01). The growing rate of thoracic spine was lower than that of cast group(0.67±0.22cm/yr,　Ｐ<0.01). At final follow-up, 2 cases continued wearing brace, 10 cases received operation. The surgery was delayed for 8.3±2.4 months and lower than that of cast group(Ｐ<0.01). Conclusions: Serial cast and brace are able to delay the first-operation for congenital scoliosis patients, while serial cast is better to control the curve progression and postpone the first-operation.