Casting Treatment Versus Growing Rods in Early-Onset Scoliosis: A Systematic Review

Study Design: Systematic review. Objective: To answer the clinical question: What is the best treatment method for correcting early-onset idiopathic scoliosis-serial casting or growing rod instrumentation? Summary of Background Data: The management of early-onset scoliosis (EOS) presents a significant challenge. While growing rods are a common surgical treatment, serial elongation, derotation, and flexion (EDF) casting has re-emerged as a valuable conservative or delaying tactic. The optimal choice between these modalities remains a subject of clinical debate. Methods: A systematic review was conducted using Medline, Embase, and Scholar databases. Eligibility criteria included studies comparing serial casting and growing rod instrumentation in patients with early-onset idiopathic scoliosis. A critical appraisal was performed to evaluate the risk of bias. Results: Four comparative cohort studies totaling 1437 patients were included. Growing rod instrumentation (GRI) resulted in significantly smaller final curves (mean 45.9 vs . 64.9°) but required longer treatment (mean 4.5 vs . 2.4 yr) and more procedures (mean 5.5 vs . 4.0). GRI had a substantially higher complication rate (44%) versus casting (one complication reported across studies). Casting effectively postponed surgery by an average of 1.7 years. Patients treated with casting demonstrated significantly better Health-Related Quality of Life (HRQoL) scores in 6/12 domains compared with traditional growing rods (TGR), with caregivers reporting improved satisfaction. Absolute spinal length was comparable between groups (mean 32.0 GRI vs . 30.6 cm cast). Conclusion: Our study suggests that serial casting is a valuable delaying strategy for younger children with early-onset scoliosis. Compared with growing rod instrumentation, casting adequately controls spinal deformity without compromising spinal length, is associated with fewer surgical complications, lower costs, and improved quality of life. Level of Evidence: Level III.