1. 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

2. 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

3. 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.

4. 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.

5. 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.

6. 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

7. 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

8. 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.

9. 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.

10. 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:
Mehta MH. Growth as a corrective force in the early treatment of progressive infantile scoliosis. J Bone Joint Surg Br. 2005; 87(9):