Mehta Scoliosis Casting

A 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 age 3), it is called infantile scoliosis. While the curve often resolves, if it doesn’t, casting is usually the first treatment choice because it offers a way to control, or even cure, scoliosis when the child is very young and not a good candidate for open surgical interventions. 

Mehta casting is a non-invasive treatment for early-onset scoliosis that involves the 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 requires that the cast be changed about every 8 weeks. With each new cast application, an attempt is made to gradually correct the curvature. The cast is made of fiberglass and applied in the operating room under general anesthesia, meaning the infant will be put to sleep during the application. 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 Treatments Are Involved?

Casting treatment is followed by bracing to maintain the correction. There are several braces available for the treatment of infantile scoliosis, and there is no consensus on which is best. Further, there is no scientific evidence that infant bracing 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 the child is weaned off the brace, provided the curvature has been corrected. Occasionally, curves recur after brace removal, necessitating the reinstitution of full-time bracing. If the curve progresses during bracing treatment, casting may be restarted, or surgery may be warranted.

Our infantile idiopathic casting program uses both the Amil and Noel casting frames.  We follow Dr. Mehta's techniques, using growth as a corrective force in the treatment of progressive infantile scoliosis.

Further information about casting, including tips for caring for a young child in a spinal cast, is available at www.infantilescoliosis.org.

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.

What Is the Casting Process?

We use a traction-derotation cast (also called a Mehta cast). This cast is applied in the OR while the child is asleep on a specially designed table.  They are then placed in halter traction, a soft brace around their chin that pulls them up, and straps tied to their waist that pull them down.

Once in halter traction, we place a cast on the child, molding it to unwind the spine, which is twisted and curved. We change the cast every 2-3 months because it tightens 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, we usually feel we have gotten the maximal benefit from this technique and will 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, let us know right away, because there might be a skin problem (a pressure sore) or the cast might be too tight around the belly, which is very rare.

Why Use Casting Instead of Bracing?

This is another good question, and I am currently participating in a randomized clinical trial to see whether bracing can be as effective as casting. An advantage of casting is that extensive research demonstrates its effectiveness, whereas 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 may do a cast holiday (and use a brace before returning to casting) if the child is experiencing skin irritation or has been in treatment for a long time. Some places in hotter climates do this routinely in the summer, but we do not in NY.