Early Treatment (ET) with Elongation, Derotation, Flexion (EDF)

I keep coming across references to ET with EDF. It stands for Early Treatment (ET) with Elongation, Derotation, Flexion ( EDF).

There are casting frames which are designed "to assist the pediatric orthopaedic surgeon in correcting an infant or young child's scoliosis three dimensionally in a series of EDF plaster casts".   

The Elongation component provides gentle traction to elongate the spine.

The Derotation components allow the surgeon to gently stabilize and derotate the pelvis. 

The Flexion component at the top of the frame provides controlled, lateral pressure to the young patient's lumbar spine and allows the surgeon to correct/maintain lordosis.

During the application of J's casts (where he's awake and traction is simply hands pressing on the bandages) I have asked about traction frames, using general anaesthetic (GA)  and derotation of the spine and met with incomprehension. Yet here is a treatment that uses it.

There's a website about such castframes. The pictures look horrendous (I have to stop imagining my little boy on there). It's worth it if it corrects the curves!

I've been in contact today with a mother whose son had a series of plaster casts applied under GA at Alder Hey - I wonder how many other places in the UK use this kind of treatment? I believe the Royal Orthopaedic Hospital in Stanmore does. Is there anywhere close to us? How do I find out?

There's an interesting article mentioned on the above site which looks at the factors that influence when casting is effective and it concludes: "Serial cast correction for infantile scoliosis often results in full correction in infants with idiopathic curves less than 60 degrees if started before 20 months of age". We don't know yet whether J has progressive scoliosis - but he's 14 months and one angle is 38* the other is 26*. I want to find out as much as I possibly can about options if it is progressive. 

2009 - Derotational Casting for Progressive Infantile Scoliosis
           Journal of Pediatric Orthopaedics:
           September 2009 - Volume 29 - Issue 6 - pp 581-587
           James Sanders, MD., Jacques D’Astous, MD., FRCS


Lots of things to bring up at next week's consultation!



*** update: I've just spotted in the paper above the following:

"Double curves are problematic in that they may have a low RVAD except at the curve junction but are nearly always progressive"

RVAD is the Rib Vertebrae Angle Difference. The renowned consultant Mehta distinguished resolving from progressive scoliosis by using the RVAD - if it is 20 degrees or more on an early supine x-ray then it's more likely to be progressive. Mr Marks said this was out dated as a technique - but I wonder whether the double curve sentence in the 2009 article above sheds a different light on it. I was told J's RVAD is less than 20 degrees - but as he has an S-shaped spine, maybe that makes it a double curve and hence may be progressive despite the RVAD??