Congenital Scoliosis
Casting

Serial casting can be used to delay the need for bracing by correcting the deformity sufficiently to allow bracing to then be re-instituted. Since a cast can be considered a full-time brace which cannot be removed, many parents find it preferable to braces, eliminating the problems of compliance and the difficulties of donning braces in uncooperative young children.

Casting can become a definitive method of management rather than simply a delay tactic. Research in the United Kingdom indicates that treating non-congenital scoliosis with serial casts beginning in children at 12 months of age with an average curve of 32° in some cases have their scoliosis reduced to up to <10° at maturity. Patients starting treatment at 18 months or later, with larger curves averaging 52°, achieve less correction, but their deformities can be maintained at a similar degree of magnitude.

Casting in children under 2 years of age, where the goal is curing the scoliosis, requires cast changes under anesthesia every 2-3 months (minimum 5 casts) with the goal of achieving a straight spine. Despite the extensive casting a brace will still be needed after the casting treatment. Children over age 2 require cast changes every 3-4 months. Older children demonstrating "recurrence" can be re-casted for four months to re-correct the deformity before continuing with brace management.

Few centers in North America use casting as a treatment method to correct a curve. The casts must be applied under general anesthesia. However a modified version of the treatment involving cast changes every three months in children with a severe curve may improve the deformity sufficiently to return to brace management and further delay the need for surgery.