Awake serial body casting for the management of infantile idiopathic scoliosis: is general anesthesia necessary?

Spine Deform. 2020 Oct;8(5):1109-1115. doi: 10.1007/s43390-020-00123-3. Epub 2020 May 7.


Study design: It is a retrospective cohort study.

Objectives: To compare the radiographic and clinical outcomes of serial body casting for infantile idiopathic scoliosis (IIS) with versus without the use of general anesthesia (GA). Serial body casting for IIS has traditionally been performed under GA. However, reports of neurotoxic effects of anesthetics in young children have prompted physicians to consider instead performing these procedures while patients are awake and distracted by electronic devices.

Methods: Patients from a multicenter registry who underwent serial casting for IIS were included. The patients were divided into asleep (GA) and awake (no GA) cohorts. Comparisons were made between pre-casting, first in-cast, and post-casting radiographic measures in each cohort. The rates of successful casting (≥ 10° major CA improvement), curve progression, and incidence of casting abandonment for surgical intervention were also compared.

Results: One-hundred and twenty-one patients who underwent serial casting for IIS were included. Ninety-two (76%) patients were asleep during casting procedures, while 29 (24%) were awake. Patients in the awake cohort were older (p < 0.01), had a lower BMI (p = 0.03), and more severe curve magnitudes (p < 0.01) at baseline. Patients in the awake cohort experienced greater first-in-cast correction of the major curve (p = 0.01) and improvement in thoracic spine height (p < 0.01). The rate of casting success was higher in the awake cohort (72%) as compared to the asleep cohort (48%) (p = 0.02), although the rate of curve progression (worsening) was similar (p = 0.880). Lastly, there was a lower rate of conversion to surgery at 2 years post-initiation of casting, although this was not statistically significant (0% vs. 8%; p = 0.126).

Conclusions: Patients who underwent awake serial casting had similar radiographic outcomes as compared to those who were under general anesthesia during the procedures. Thus, awake casting may provide a safe and effective alternative to the use of general anesthesia in patients with idiopathic infantile scoliosis.

Level of evidence: III.

Keywords: Early-onset scoliosis; General anesthesia; Infantile idiopathic scoliosis; Mehta casting.

Publication types

  • Comparative Study

MeSH terms

  • Age Factors
  • Age of Onset
  • Anesthesia, General* / adverse effects
  • Anesthetics / adverse effects
  • Casts, Surgical*
  • Child
  • Child, Preschool
  • Cohort Studies
  • Female
  • Humans
  • Infant
  • Male
  • Retrospective Studies
  • Safety
  • Scoliosis / diagnostic imaging
  • Scoliosis / therapy*
  • Treatment Outcome
  • Unnecessary Procedures*
  • Wakefulness*


  • Anesthetics