Journal of Children's Orthopaedics - 2026-08-28 - Journal Article; Review
Benefits and complications: A systematic review and meta-analysis of serial casting in early onset scoliosis.
Sharma S, Ramnarine A, Fouad K, Cheung A, Khurana V, Sankar S, O'Connor M, O'Byrne GP, Boughton O, Kiely P
Topics
Key Takeaway
Serial casting in early-onset scoliosis carries a pooled complication rate of 17% (95% CI 9–24%), with dermatological complications predominating and significantly fewer complications than growth rods (1/27 vs 12/27).
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Summary
This systematic review and meta-analysis synthesized evidence on serial casting outcomes in EOS across 23 studies identified from 578 records, using random-effects models for quantitative pooling. The pooled complication rate was 17% (95% CI 9–24%), driven predominantly by dermatological events; comparative data showed casting produced fewer complications than growth rods (1/27 vs 12/27). Cobb angle correction was greater in non-congenital than congenital EOS, pulmonary function transiently declined during casting but recovered post-removal, and residual curvature inversely correlated with quality-of-life domains.
Key Limitation
The absence of reported total patient numbers across included studies and moderate heterogeneity in the pooled complication estimate limit confidence in the precision of the 17% figure.
Original Abstract
PURPOSE
Early-onset scoliosis (EOS) presents a unique therapeutic challenge, requiring interventions that achieve deformity correction while preserving spinal and thoracic growth. This systematic review and meta-analysis aimed to synthesise current evidence on serial casting outcomes in EOS, with a primary focus on treatment-related complications and secondary evaluation of radiographic, pulmonary, and quality-of-life outcomes.
METHODS
Comprehensive searches were performed in MEDLINE, Embase, Cochrane Library and CINAHL without date restrictions to identify eligible studies. The primary outcome was treatment-related complications; secondary outcomes included Cobb angle correction, thoracic height progression, pulmonary function, and patient-reported quality of life. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tools. Meta-analyses were conducted using random-effects models, and narrative synthesis was applied where quantitative pooling was not feasible.
RESULTS
From 578 records, 23 studies met inclusion criteria. Sixteen studies were rated as low risk of bias, six moderate, and one high. The pooled complication rate from the single-arm meta-analysis was 17% (95% CI 9-24%), with moderate heterogeneity. Dermatological complications predominated (skin irritation, ulceration), while gastrointestinal and transient respiratory symptoms were infrequent. Comparative studies demonstrated lower complication rates with casting compared to growth rods (1/27 vs 12/27), with outcomes comparable or superior to bracing. Mean annual thoracic growth ranged from 0.8 to 3.8 cm. Cobb angle correction was generally greater in non-congenital compared to congenital scoliosis. Pulmonary function may transiently decline during casting but improves following cast removal, while long-term outcomes remained acceptable when early surgery was avoided. Quality-of-life analysis demonstrated inverse associations between residual curvature and domains including daily living, pain, and emotional wellbeing.
CONCLUSION
Serial casting remains an effective, low-risk, and growth-preserving intervention for managing early-onset scoliosis. The predominance of minor, reversible complications underscores its safety, while radiographic and functional outcomes affirm its therapeutic value. Future research should prioritise prospective evaluation of pulmonary and psychosocial outcomes to optimise patient selection and refine treatment protocols.