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Elongation, Derotation, and Flexion Casting on a Jackson Table

March 01, 2020

Contributors: Kali R Tileston, MD, FAAOS; Japsimran Kaur, BS; Celeste Brody, RN; Meghan N Imrie, MD, FAAOS; James Policy, MD, FAAOS; Lawrence A Rinsky, MD, FAAOS; John Vorhies, MD; Blake Montgomery, MD

Keywords: Scoliosis

2020 AWARD WINNER Early onset scoliosis may result in poor pulmonary function and quality of life. Serial elongation, derotation, and flexion (EDF) casting is an effective treatment option for patients with early onset scoliosis, delaying surgical treatment and, sometimes, successfully managing early onset scoliosis. Most described casting techniques require a specialized frame or casting table, which are not available at many institutions. We describe a novel technique for EDF casting on a Jackson table modified to function as a traction frame. This video compares the results of EDF casting on a modified Jackson table with those of EDF casting on a traditional Risser frame. We identified and retrospectively reviewed patients who underwent EDF casting for the management of early onset scoliosis at our institution between January 2015 and January 2019. We stratified patients based on the type of table used and compared clinical and radiographic outcomes. Standard descriptive statistics were calculated. We identified 25 patients who underwent 74 casting events, 11 of whom underwent casting on an modified Jackson table and 14 of whom underwent casting on a Risser frame. Mean follow-up was 18 months (range, 4 to 46 months). Idiopathic scoliosis was present in 28% of the patients. No significant difference was reported in patient age at initiation of casting (P = 0.298), the initial Cobb angle (P = 0.965), or the rate of idiopathic scoliosis between the two group. No significant difference was reported in cast-related complications and initial coronal Cobb angle correction (P = 0.789) between the two groups. A significant difference in surgical time was reported, with the surgical time for the modified Jackson table group being 16 minutes shorter than that for the Risser frame group (P = 0.010). We found no differences in complication rate or the magnitude of initial in-cast correction between the two groups. A modified Jackson table is a safe and effective alternative for EDF casting under traction.

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