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Abstract from the SRS 2004 Annual Meeting
Introduction: The incidence of paralytic scoliosis subsequent to acquired
spinal cord injury (SCI) has been reported to range from 46% to 97% in patients
injured prior to the adolescent growth spurt. The purpose of this report is
to review early bracing of children with SCI as a means of preventing or delaying
surgical fusion to allow for growth of the spine.
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.
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