• Cody Shafer, Rajat Mahajan, and Shyam Kishan.
• Orthopedic Surgeon, Indianapolis, IN.
• Spine. 2021 Jul 1; 46 (13): 852-860.

Study DesignIRB approved prospective case series.ObjectivesThis study attempts to determine the effects of elongation, derotation, and flexion (EDF) casting on pulmonary function. We also attempted to define prognostic factors and determine the ideal amount of traction for casting in patients with early onset scoliosis (EOS).Summary Of Background DataNo literature on effects of serial casting on pulmonary parameters in EOS, or on the ideal amount of traction to be used for EOS Casting.MethodsFifty consecutive children with EOS treated by the senior author using EDF casting were studied prospectively. Traction and lung function parameters (compliance, tidal volume, peak inspiratory pressure, and resistance) were measured at different periods during cast application. Etiology, age, weight, Cobb angles, and RVAD were monitored.ResultsAll lung function parameters decline during cast application but rise to near baseline levels at the time of next cast application. Near full curve correction was achieved in every patient with (A) idiopathic scoliosis who (B) presented prior to 20 months of age with (C) a moderate main curve at presentation (<45°) and in those (D) without a phase II rib-vertebral relationship at presentation. The best response to casting was seen with 1 pound traction per pound body weight during application.ConclusionEDF casting can delay progression or improve curves in patients with larger curves, nonidiopathic scoliosis, and older patients. Idiopathic patients, moderate curve sizes, and younger patients had a better response to casting. Even though lung function declines during cast application, it returns to near baseline levels at the time of the next cast application, suggesting that EDF casting may not have any long-term effects on lung function, and also may protect pulmonary function in EOS from its natural history of progressive deterioration.Level of Evidence: 4.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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