110A 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

DisclosuresAnari: 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

BackgroundThe 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 QuestionHow does serial casting effect the psychological,

behavioral, and cognitive development of the growing child?Use the Parental Stress Index (PSI) to assess the

parent-child relationship.Use the Behavior Assessment System for Children

(BASC) to assess child behavior.

HypothesisPSI 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.

MethodsDiagnosis: Infantile idiopathic scoliosis

Prospective enrollmentBASC & PSI Questionnaires

Pre-castPost-castFollow-up visits

Higher BASC scores are more normative

Higher PSI scores indicate more parental stress

ResultsTable 1: Infantile Idiopathic Scoliosis BASC & PSI Scores with Mehta Casting

Patient Number BASC PSI

Pre-cast 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

Average 194 221 48 46

p-Value BASC-0.086 PSI-0.539

DiscussionAlthough the data is limited, a slight trend

of increasing post casting BASC scores suggests Mehta casting may negatively impact behavior and emotional status in children.

Results from the PSI questionnaire were inconclusive at this time to draw any formative conclusions.

ConclusionWe 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.

ReferencesSanders 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.