110 A New Angle on Mehta Casting in Infantile Idiopathic Scoliosis: Effect on Patient and Mother Jason B. Anari, MD*; Sumeet Garg, MD#; Peter F. Sturm, MD&; Patrick J. Cahill, MD*; Children's Spine Study Group *Children’s Hospital of Philadelphia-Philadelphia #Children’s Hospital Colorado, Aurora &Cincinnati Children’s Hospital, Cincinnati

Disclosures Anari: Nothing to disclose Cahill: Consultant DePuy Synthes Spine, Ellipse Technologies, Globus Medical, Medtronic Garg: Consultant Medtronic Sturm: Consultant DePuy Spine, Ellipse Technologies, Medtronic Children's Spine Study Group: Depuy Synthes

Background The natural history of untreated progressive Infantile Idiopathic Scoliosis (IIS) is at best severely disfiguring and at worst deadly. Treatment often consists of either bracing or Mehta casting. The repeated trips to the operating room with serial Mehta casting has been associated with peri-anesthesia risks in infants and toddlers including death, pneumonia, pneumothorax, anoxic brain injury, and development of allergic reactions to medications. No studies have evaluated the long-term psychological and social effects of repeated general anesthesia in very young children on domains such as behavior, cognition, and the parent-child relationship in the IIS population.

Clinical Question How does serial casting effect the psychological, behavioral, and cognitive development of the growing child? Use the Parental Stress Index (PSI) to assess the parent- child relationship. Use the Behavior Assessment System for Children (BASC) to assess child behavior.

Hypothesis PSI scores would decrease with time and increasing number of cast changes. BASC scores would elevate with time as the child becomes more accustomed to life with a body cast.

Methods Diagnosis: Infantile idiopathic scoliosis Prospective enrollment BASC & PSI Questionnaires Pre-cast Post-cast Follow-up visits Higher BASC scores are more normative Higher PSI scores indicate more parental stress

Results Table 1: Infantile Idiopathic Scoliosis BASC & PSI Scores with Mehta Casting Patient Number BASC PSI   Pre-cast Post-cast Patient 1 106 212 71 62 Patient 2 197 183 52 38 Patient 3 224 46 53 Patient 4 152 239 43 Patient 5 132 173 59 42 Patient 6 217 233 37 32 Patient 7 231 35 34 Patient 8 228 240 48 Patient 9 256 261 Patient 10 56 Patient 11 Patient 12 74 Patient 13 36 66 Average 194 221 p-Value BASC-0.086 PSI-0.539

Discussion Although the data is limited, a slight trend of increasing post casting BASC scores suggests Mehta casting may negatively impact behavior and em otional status in children. Results from the PSI questionnaire were inconclusive at this time to draw any formative conclusions.

Conclusion We recognize the importance of continuing to evaluate the behavioral and cognitive maturation of children with IIS who are treated with Mehta casting. Additional follow up at time points further out from the initial cast will give us a better understanding of the long term effects of this non-operative modality used to manage IIS.

References Sanders JO, D’Astous J, Fitzgerald M, Khoury JG, Kishan S, Sturm PF. Derotational Casting for Progressive Infantile Scoliosis. J Pediatr Ortho. 2009; 29:581-587. Mehta MH. Growth as a corrective force in the early treatment of progressive infantile scoliosis. J Bone Joint Surg Br. 2005; 87(9):1237-47.