Weight gain and gastrostomy tube safety during serial body casting for early onset scoliosis

Purpose Serial casting has been shown to improve curve deformity for patients with early-onset scoliosis (EOS). However, despite prior literature demonstrating the importance of weight and nutrition in EOS patients, there is limited information regarding complications and weight gain ability for children undergoing serial casting. Additionally, parents of patients undergoing serial casting often have concerns regarding weight gain and patient comfort, which tend to be amplified in patients with gastrostomy tubes (g-tubes). We aim to understand changes in weight, g-tube complications, and cast-related complications in patients being treated with serial casting. Methods A single center retrospective review of all EOS patients less than 6 years old treated with serial casting was performed. Patient weight out of cast throughout their treatment was converted to a percentile based on CDC growth charts. Patients with documented calls regarding cast concerns, complications requiring cast removal, or g-tube procedures were recorded. Results A total of 32 patients treated with serial casting were included with four having g tubes. Overall, the average weight percentile increased from pre-casting to post-casting (27–38%, p < 0.001) with 21 patients showing an increase. Of the 22 patients with a starting weight below the 25th percentile, 14 (64%) demonstrated an increase. Patients with g tubes increased an average of 4.2 kg during casting compared to 3.0 kg in patients without g tubes ( p = 0.588). 18 parents registered a cast concern during the treatment and 5 patients required at least one early cast removal. No difference in cast concerns ( p = 0.597) or cast removals ( p = 0.488) was observed when comparing patients with g tubes to those without. There were no instances of g-tube dysfunction during casting. Conclusion While the average weight percentile for patients initiating serial casting is below average, the majority increased their weight percentile during treatment. Patients with and patients without g tubes were able to maintain or gain weight during casting treatment. While it was common for parents to contact providers with cast concerns, patients with g tubes did not appear to have a greater risk of cast or g tube-related complications. Level of evidence Level IV.