Effect of bracing on paralytic scoliosis secondary to spinal cord injury.

Samir Mehta, Randal R. Betz, M. J. Mulcahey, Craig M McDonald, Lawrence C. Vogel, Caroline Anderson

Research output: Contribution to journalArticle

38 Scopus citations

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 1996 to December 2001 from the Shriners Hospitals for Children-Philadelphia were retrospectively reviewed; 123 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 degrees, 29 of whom were braced, and 13 who were not. Of the braced group, 13 (45%) went on to surgery, whereas 10 (77%) of the nonbraced group had surgical correction (P = 0.03). Of the patients who were initially braced, the average time to surgery was 8.5 years, whereas that for the nonbraced group was 4.2 years (P = 0.002). A similar trend was seen in the patients who presented with an initial curve between 11 degrees and 20 degrees (P < 0.001). There was no significant difference between time to surgery for the braced and nonbraced patient groups at higher (> 20 degrees) initial curve presentations. CONCLUSION: Bracing of children with SCI before significant curve formation (< 20 degrees) delays the time to surgical correction of the deformity as it progresses. At smaller curves (< 10 degrees), bracing may even prevent the need for surgery. As curve size increases (> or = 20 degrees), bracing seems to play a limited role, because it does not seem to prevent surgery or delay time to surgical correction.

Original languageEnglish (US)
JournalThe journal of spinal cord medicine
Volume27 Suppl 1
StatePublished - 2004
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology

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    Mehta, S., Betz, R. R., Mulcahey, M. J., McDonald, C. M., Vogel, L. C., & Anderson, C. (2004). Effect of bracing on paralytic scoliosis secondary to spinal cord injury. The journal of spinal cord medicine, 27 Suppl 1.