Mehta Casting

Mehta casting is a non-invasive treatment option for young children with early-onset scoliosis, who are not good candidates for surgical intervention. Mehta casting involves applying a series of custom casts to the patient, using a table designed to help our doctors correct the curves in the spine.

With early-onset scoliosis, our goal is to delay–and hopefully avoid–the need for surgery. When Mehta casting treatment is started early on, it can be very successful in correcting mild to moderate curves in the spine and improving more severe curves.

Dr. Ryan Fitzgerald is an experienced surgeon with specialized training in waterproof Mehta casting techniques who is joining our practice from the midwest. Dr. Fitzgerald trained at the world-renowned Rady Children’s Hospital in San Diego, CA, and is highly involved in the Scoliosis Research Society. He has been instrumental to the adoption of waterproof Mehta casting at several centers across the US, helping to create instructional videos that have been featured through the Pediatric Orthopedic Society of North America (POSNA).

What Does Mehta Casting Involve?

A Mehta cast is a special type of cast applied to the child’s trunk that uses traction to help correct spinal curves caused by early-onset scoliosis. The casts are made from aquacast liner and fiberglass (instead of plaster) so they are waterproof. Benefits of fiberglass casts include being immediately cleared for bathing, swimming, and showering after the cast is applied, and there is no need for cast holidays.

Our doctors use a special table called a Mehta table that allows them to mold the cast in a way that will gently and gradually unwind the curves in the spine. The cast has a mushroom shaped opening in the front of the cast to allow the child to breathe and move more easily. Unlike other scoliosis casting options, Mehta casting has a very low risk of causing rib and chest problems, making it safe to use on children under the age of 4.

Mehta casts are applied in the operating room while the child is under general anesthesia. The casts are typically replaced every 8-16 weeks. Although cases do vary, most children are able to be treated and potentially cured of their infantile idiopathic scoliosis in 12 months. Most studies show an average of 5 casts. However, depending on how they respond to the cast, it can be more or less than that.

Caring for a Child with a Mehta Cast

Proper cast care is very important for a child with a Mehta cast. Here are some of the key things to do when taking care of a Mehta cast patient:

Dressing & Undressing

• You will likely need to get larger shirts for your child so that they fit over the cast comfortably.
• Shirts with buttons or snaps may be helpful in dressing and undressing.
• For bottoms, elastic waistbands tend to work best.

Watch this video demonstration of how to change your child’s shirt with a Mehta cast.

Skin Care

The cast can irritate the child’s skin, and skin infections can develop under the cast. Regular checks and proper skin care are very important.

• Do not use lotions, creams, or powders on the skin under or near the cast.
• Never insert items under the cast. If the skin under the cast is scratched, it can become infected.
• Avoid sandboxes and the beach to prevent sand from getting underneath the cast and irritating the skin.
• Moleskin may also be applied to parts of the cast to prevent skin irritation.
• Regularly check your child for signs of skin irritation, infection, changes in color or temperature of the limbs, and ability to move.

Itching

Itching is a common complaint with Mehta casts. Here are a few tips for avoiding itching:

• If itching occurs, you can use a blow dryer on a cool setting.
• Keep the child out of direct sunlight, which can cause increased sweating that leads to itching.
• Try a cooling vest, which can help prevent or reduce sweating and itching in the hot Florida weather. They can be purchased here.
• Submerging the whole cast in water will rinse out dead skin and sweat which could be causing irritation.
• Ask your doctor about giving your child allergy medication if itching persists.

CALL US IMMEDIATELY IF:

• The cast gets very wet and cannot be dried with a hair dryer on a cool setting.
• The cast softens or cracks.
• An object falls into the case and is stuck.
• The cast appears to be too tight and is restricting movement.
• There is a foul odor coming from the cast.
• Your child complains of increased pain that is not relieved with medication or position change.
• Your child develops a fever of 101°F or higher.
• Your child appears to have a skin infection.
• Your child shows signs that the cast is getting too tight, including vomiting or burping frequently, or eating and drinking less than usual.

Our phone number is (727) 898-2663. If your call is after our regular business hours, our answering service will page our provider on-call for you.

Frequently Asked Questions About Mehta Casting

Q: When do you stop casting?
A: If the curve reduces to less than 10 degrees, then we usually consider this a cure and transition to a brace. Alternatively, if we see no improvement over 2-3 casts consecutively, then we usually feel that maximal benefit has been reached and we also transition to bracing.

Q: Does the cast hurt?
A: No – the cast should not hurt. If your child is reporting sustained pain, you need to let us know immediately, because this might indicate a skin issue or pressure sore. This is quite rare, but around the armpits and hips are common problem areas.

Q: Why can’t we use a brace?
A: An advantage of casting is that it has been shown that casting can be very effective, and there is little to no research that shows bracing is as effective in infantile idiopathic scoliosis. At this time, there is a randomized clinical trial testing this that we are participating in in conjunction with doctors around the world through the Pediatric Spine Study Group.

Q: Can the cast get wet?
A: Unless told otherwise, all of our casts are waterproof. With that being said, it can only be submerged in bathtubs, showers, and swimming pools with appropriate flotation devices. The casts should not be put in hot tubs, rivers, lakes, streams, the Gulf, or any other fresh or saltwater bodies.

Q: Can we take the cast to the beach?
A: NO! Sand and dirt inside the cast while in small amounts can be rinsed out. In large amounts, it will cause severe skin irritation and issues for your child. Stay away from the beach or sand boxes while casting.

Q: Does the cast get hot or itchy?
A: Yes, but with the casts that we use, you can run water through to quickly cool your child down or calm that pesky itch. If this does not resolve the itching, consider running a hair dryer on cool at the edges of the cast. Finally, for severe itching you can use an antihistamine such as Benadryl or Children’s Allegra. DO NOT PUT ANYTHING IN YOUR CAST!

Q: How do you keep the skin healthy?
A: Do not put anything under your child’s cast. Teach your child not to, either. The skin can be easily scratched and infected. Never use lotions, creams, powders, or essential oils on the skin around or under the cast. This will soften the skin and cast, which can make them both more easily damaged.