Effect of Bracing on Paralytic Scoliosis Secondary to Spinal Cord Injury

Abstract

Background: The incidence of paralytic scoliosis subsequent to acquired spinal cord injury (SCI) has been reported to range from 46% to 97% in patients injured before the adolescent growth spurt.Objective: The purpose of this report is to review early bracing of children with SCI as a means of preventing or delaying surgical fusion.Methods: Patient records from January 1 996 to December 2001 from the Shriners Hospitals for Children-Philadelphia were retrospectively reviewed; 1 23 patients met the inclusion criteria of cervical or thoracic SCI prior to skeletal maturity. Patients were divided into 5 groups based on their radiographic curve severity at presentation, and then they were subdivided into a group that was managed with prophylactic bracing and a group that was not braced. End-points included completion of bracing regimen, surgery, or cessation of growth.Results: Forty-two patients presented with a curve < 10°, 29 of whom were braced, and 13 who were not. Ofthe braced group, 13 (45%) went on to surgery, whereas 10 (77%) ofthe nonbraced group had surgical correction (P = 0.03) . Ofthe patients who were initially braced, the averagetime to surgery was 8.5 years, whereas that for the nonbraced group was 4.2 years (P = 0.002). A similar trendwas seen in the patients who presented with an initial curve between 11 ° and 20° (P < 0.001). There was no significant difference between time to surgery for the braced and nonbraced patient groups at higher (> 20°) initial curve presentations.Conclusion: Bracing of children with SCI before significant curve formation (< 20°) delays the time to surgical correction of the deformity as it progresses. At smaller curves (< 10°), bracing may even prevent the need for surgery. As curve size increases (2≥20°), bracing seems to play a limited role, because it does not seem to prevent surgery or delay time to surgical correction.