Spinal Casting for the Treatment of Severe Early Onset Scoliosis: Utilization of a Nonsurgical Health Care Provider for Cast Application.

ABSTRACT

BACKGROUND: Spinal casting with the aim of delaying surgical intervention is a widely accepted but resource intensive conservative management strategy used by spine surgeons to treat severe early onset scoliosis. Opting to use a nonsurgical health care provider for cast application may be an effective use of human resources if the quality of care is not compromised. This study aimed to evaluate the outcomes of spinal cast treatment utilizing a nonsurgical health care provider for cast application. METHODS: This is a chart and radiographic review of all 30 patients that initiated spinal cast treatment between 2007 and 2018 and have at least 2-year follow-up. A spine surgeon applied all casts before July 14; a physical therapist (PT) applied all subsequent casts. Comparative analyses were performed for baseline data and the amount of correction achieved in initial cast. Complications and delay time to surgery were recorded. RESULTS: The PT cast 16 patients (12 female, 10 idiopathic, 64 casts total), average age 3.8±1.4 years and mean major curve of 63±18 degrees. Similarly the spine surgeon cast 14 patients (11 female, 8 idiopathic, 53 casts total), average age 4.4±1.7 years (P=0.30) and mean major curve of 63±11 degrees (P=0.93). In the initial cast the PT obtained 55%±13% (28±12 degrees) correction and the surgeon 44%±12% (36±12 degrees, P=0.09). The average number of casts was similar (4.0 vs. 3.8, P=0.7). The PT had 1 patient develop superior mesenteric artery syndrome, which resolved with cast removal, and the surgeon had 2 patients require extra care related to skin breakdown. With average follow-up of 4.15 years (range, 2.0 to 5.8 y) 11/14 PT patients demonstrate curve improvement compared with their initial presentation and 2 patients have undergone surgical intervention (3.2 and 4.3 y after first cast). The surgeon's average delay time to surgery was 4.3 years (range, 1.8 to 8.7 y after first cast, n=10). CONCLUSIONS: The results of this study support our current model of care utilizing a nonsurgical health care practitioner for spinal cast application. LEVEL OF EVIDENCE Level III-retrospective comparative.