Mehta Scoliosis Casting

What is Mehta Scoliosis Casting?

The very young child with scoliosis is often not a candidate for surgery and in fact may not need surgery. When very young children have scoliosis (usually under the age of 3) we call this infantile scoliosis. While often the curve goes away, if it doesn’t, casting is usually the first treatment choice because it offers a way to control, or even cure, the scoliosis when the child is very young and not a good candidate for any open surgical interventions.  Mehta casting is a non-invasive treatment for managing early onset scoliosis that involves serial application of customized casts. The patient's casts are applied to the trunk on a specially designed table that allows us to control and correct the curves

Serial casting treatment reatment requires that the cast be changed about every 8 weeks. With each new cast application there is an attempt to gradually correct the curvature. The cast is made of fiberglass, and is applied in the operating room under general anesthesia, which means that the infant will be put to sleep through the application process. This enables our specialized team to apply the cast under ideal conditions while the infant is sleeping. Correction is usually achieved by around 18 months of age.What Other Treatment's Are Involved?

Casting treatment is followed up with bracing treatment, which is needed to maintain the correction.  There are a number of braces available for treatment of infantile scoliosis and there is no consensus on which is the best. Further, there is no scientific evidence that bracing in infants alters the natural history of this condition. Except for bathing and exercise, the brace is to be worn all the time, usually for 2 to 3 years, after which time the child is weaned off the brace, provided correction of the curvature has been maintained. Occasionally, curves recur after brace removal, which necessitates reinstitution of full-time bracing treatment.  If the curve progresses during bracing treatment casting may be restarted or surgery may be warranted.

Our infantile idiopathic casting program utilizes both the Amil casting frame and Noel casting frame.  We follow the techniques of Dr. Mehta to utilize growth as a corrective force in the treatment of progressive infantile scoliosis. Further information about casting, including tips for care of the young child in a spinal cast, is available at www.infantilescoliosis.org.

Commonly Asked Questions and Answers by Dr. Benjamin Roye: 

How many casts will my child need? 

Most studies show an average of 5 casts, which can mean almost 1 year in a cast. However, depending on how they respond to the cast, it can be more or less than that.

Can you tell me more about the casting process?

We use a traction-derotation cast (also called a Mehta cast). This cast is put on in the OR while the child is asleep on a specially made table.  They are then placed in halter traction, which is a soft brace around their chin pulling up and straps tied to their waist pulling down. Once in the halter traction, we place a cast on the child, molding it, so it will unwind the spine which is twisted as well as curved.  We change the cast every 2-3 months because the cast gets tight as the child grows.  Most kids have no difficulty adjusting to the cast. The goal of treatment is to have the curve go away completely, or have it stabilized and improve somewhat to delay more aggressive treatment. 

When do you stop casting? 

This is a great question that has a couple of answers.  If the cast remains less than about 15 degrees for 2 casts, then we usually consider that a cure and transition to a brace.  Alternatively, if we don’t see any improvement in 2-3 consecutive casts, then we usually feel like we have gotten the maximal benefit from this technique and will usually move on to bracing as well. 

Does the cast hurt? 

No – the cast should not hurt.  If you think your child is in pain or very uncomfortable you need to let us know right away, because there might be a skin problem (pressure sore) or the cast might be too tight around the belly, which is very rare. 

Why can’t we just use a brace instead of casting? 

This is another good question, and there is currently a randomized clinical trial going on, that I am participating in, to see if bracing can be as effective as casting.  An advantage of casting is that there is a lot of research showing how effective it can be, and there is little to no research on bracing infants with scoliosis.  Part of the reason for this is that it is hard to make a brace that fits a very small child well. 

What about in the summer when it is hot – can the brace get wet? 

Unfortunately, most of these casts cannot be submerged in water and should stay dry.  Sponge baths are the order of the day in these casts.  However, at times we will do a cast holiday (and use a brace before going back to casting) if the child is having problems with skin irritation or if they’ve been in treatment for a long time.  Some places in hotter climates do this routinely in the summer, but we do not in NY.