AB252. SOH26AB_0031. Balancing curve correction and complications: a systematic review and meta-analysis of Mehta casting in early-onset scoliosis

Background: Early-onset scoliosis (EOS) presents a unique therapeutic challenge, requiring interventions that achieve deformity correction while preserving spinal and thoracic growth. Among non-surgical modalities, Mehta elongation-derotation-flexion casting has demonstrated substantial efficacy in curve modulation; however, the safety profile and spectrum of complications associated with this approach remain poorly characterised. We aimed to address this deficit.

Methods: Comprehensive searches were performed in MEDLINE, Embase, Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for eligible studies. 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: Of 578 records, 23 studies met the 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% confidence interval (CI): 9–24%], with moderate heterogeneity. Dermatological complications predominated (skin irritation, ulceration), while gastrointestinal and transient respiratory symptoms were infrequent. No study reported thoracic compartment syndrome. Comparative studies demonstrated lower complication rates with casting compared to growth rods (1/27 vs. 12/27), and outcomes comparable or superior to bracing. Mean annual thoracic growth ranged 0.8–3.8 cm, and Cobb angle correction was significantly greater in non-congenital than in congenital scoliosis (P<0.05). Pulmonary function transiently declined during casting but improved post-removal, while long-term outcomes remained acceptable when early surgery was avoided. Quality-of-life analysis revealed inverse associations between residual curvature and domains including daily living, pain, and emotion.

Conclusions: Mehta casting remains an effective, low-risk, and growth-preserving intervention for managing EOS. Future research should prioritise standardised complication reporting and prospective evaluation of pulmonary and psychosocial outcomes to optimise patient selection and refine treatment protocols.

Keywords: Complications; early-onset scoliosis (EOS); Mehta casting; meta-analysis; outcomes