The Effect of Bracing on Paralytic Scoliosis Secondary to Spinal Cord Injury

Methods: Patient records from January 1996 to December 2001 were retrospectively reviewed. 123 patients met the inclusion criteria of cervical or thoracic SCI with neurologic deficit and a minimum of 2 years followup. Patients were divided into five groups based on their radiographic curve severity at presentation. Each of these groups was subdivided into a group that was initially managed with bracing and a group that was not braced. End-points included completion of bracing regimen, surgery, or cessation of growth. Univariate and multivariate analyses were performed.

Results: The average age at time of injury was 4 years (range, 15 days to 12 years), with average age at presentation of 6.5 years (range, 1 year to 11 years). Follow-up was 7 years (range, 2 to 13 years). 42 patients presented with a curve less than 10°, 29 of whom were managed with a brace and 13 without. Of the braced group, 13 went on to surgery while 10 of the non-braced had surgical correction (p=0.03). Of the patients who were initially braced, the average time to surgery was 8.5 years, while time to surgery for the non-braced group was 4.2 years (p=0.002). Similarly, of the 18 braced children in the 10 to 20° group, 9 had subsequent surgery 6.8 years after presentation, while 6 of the 7 patients in the non-braced group had surgery 3.7 years after presentation (p<0 .001). There was no significant difference between time to surgery for the braced and non-braced patient groups at higher initial curve presentations (>20°).

Discussion: Bracing of children with SCI prior to significant curve formation (<20 °) delays the time to surgical correction of deformity as it progresses. At smaller curves (< 20°), bracing may even prevent need for surgery. As curve size increases, plays a limited role, does not appear surgery or delay correction.