Transcript 110 A New Angle on Mehta Casting in Infantile Idiopathic Scoliosis

110
A New Angle on Mehta Casting in
Infantile Idiopathic Scoliosis: Effect
on Patient and Mother
Jason B. Anari, MD*; Sumeet Garg, MD#; Peter F. Sturm, MD&; Patrick J. Cahill, MD*;
Children's Spine Study Group
*Children’s Hospital of Philadelphia-Philadelphia
#Children’s Hospital Colorado, Aurora
&Cincinnati Children’s Hospital, Cincinnati
Disclosures
 Anari: Nothing to disclose
 Cahill: Consultant DePuy Synthes Spine, Ellipse
Technologies, Globus Medical, Medtronic
 Garg: Consultant Medtronic
 Sturm: Consultant DePuy Spine, Ellipse Technologies,
Medtronic
 Children's Spine Study Group: Depuy Synthes
Background
 The natural history of untreated progressive Infantile
Idiopathic Scoliosis (IIS) is at best severely disfiguring and
at worst deadly. Treatment often consists of either bracing
or Mehta casting.
 The repeated trips to the operating room with serial Mehta
casting has been associated with peri-anesthesia risks in
infants and toddlers including death, pneumonia,
pneumothorax, anoxic brain injury, and development of
allergic reactions to medications.
 No studies have evaluated the long-term psychological and
social effects of repeated general anesthesia in very young
children on domains such as behavior, cognition, and the
parent-child relationship in the IIS population.
Clinical Question
 How does serial casting effect the psychological,
behavioral, and cognitive development of the growing
child?
 Use the Parental Stress Index (PSI) to assess the parentchild relationship.
 Use the Behavior Assessment System for Children
(BASC) to assess child behavior.
Hypothesis
 PSI scores would decrease with time and increasing
number of cast changes.
 BASC scores would elevate with time as the child
becomes more accustomed to life with a body cast.
Methods
 Diagnosis: Infantile idiopathic scoliosis
 Prospective enrollment
 BASC & PSI Questionnaires
 Pre-cast
 Post-cast
 Follow-up visits
 Higher BASC scores are more normative
 Higher PSI scores indicate more parental stress
Results
Table 1: Infantile Idiopathic Scoliosis BASC & PSI Scores with Mehta Casting
Patient Number
BASC
Pre-cast
PSI
Post-cast
Pre-cast
Post-cast
Patient 1
106
212
71
62
Patient 2
197
183
52
38
Patient 3
224
212
46
53
Patient 4
152
239
43
46
Patient 5
132
173
59
42
Patient 6
217
233
37
32
Patient 7
231
239
35
34
Patient 8
228
240
34
48
Patient 9
256
261
Patient 10
56
43
Patient 11
37
32
Patient 12
74
52
Patient 13
36
66
48
46
Average
p-Value
194
BASC-0.086
221
PSI-0.539
Discussion
 Although the data is limited, a slight trend
of increasing post casting BASC scores suggests
Mehta casting may negatively impact behavior and em
otional status in children.
 Results from the PSI questionnaire were inconclusive
at this time to draw any formative conclusions.
Conclusion
 We recognize the importance of continuing to evaluate
the behavioral and cognitive maturation of children with
IIS who are treated with Mehta casting.
 Additional follow up at time points further out from the
initial cast will give us a better understanding of the long
term effects of this non-operative modality used to
manage IIS.
References
 Sanders JO, D’Astous J, Fitzgerald M, Khoury JG,
Kishan S, Sturm PF. Derotational Casting for
Progressive Infantile Scoliosis. J Pediatr Ortho. 2009;
29:581-587.
 Mehta MH. Growth as a corrective force in the early
treatment of progressive infantile scoliosis. J Bone Joint
Surg Br. 2005; 87(9):1237-47.