MYTH vs.TRUTH: Mehta Casts Always Work

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Presentation transcript:

MYTH vs.TRUTH: Mehta Casts Always Work ICEOS 2009, Istanbul MYTH vs.TRUTH: Mehta Casts Always Work Mr MHH Noordeen FRCS Great Ormond Street Hospital for Children The Royal National Orthopaedic Hospital London, UK

MEHTA’S PHILOSOPHY Mehta unique experience with infantile scoliosis. Early rapid growth, if guided by the cast, would assist an initially curved spine to straighten

PREREQUISITES: SURGEON Cotrel and Morel EDF: Elongation Derotation Flexion. Special Table Meticulous Technique Derotational Casting for Progressive Infantile Scoliosis James O. Sanders, MD et al; J Pediatr Orthop 2009

PREQUISITES: PATIENT Idiopathic Infantile Flexible Smaller Cobb’s Younger ages (preferably 1-2 years, may be 3 yrs old) Phenotypes

MEHTA’S NEVER MATCHED RESULTS Review of 136 patients with infantile scoliosis treated with serial casting. Program of serial cast changes under anaesthesia every 8-16 weeks until the curve was nearly resolved. Subsequent bracing followed with an underarm brace. Results revealed casting achieved full correction in 94 patients, and only partial correction in 42. Treatment was much more likely to be successful if started before the age of 2 years. James Sanders and Jacques D’Astous had promising results with the same technique (minimal modifications)

INDEPENDENT EVALUATION Single report for a life long personal experience. Some of infantile curves resolves even with higher Rib Vertebral Angles. Best in the 1st and 2nd year of life. Sturdy phenotypes responded the best. Needs to be adopted and executed by many Centers.

CONCLUSION Mehta Casts can correct infantile scoliosis in selected patients. For Infantile Progressive Scoliosis there are no many available options. Casts are a good delaying tactic. Casts work better if started as early as 1st year of life Casting program should be stopped once failed especially when available options are possible.