Effect of bracing on paralytic scoliosis secondary to spinal cord injury

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.The purpose of this report is to review early bracing of children with SCI as a means of preventing or delaying surgical fusion.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.Forty-two patients presented with a curve10 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 (P0.001). There was no significant difference between time to surgery for the braced and nonbraced patient groups at higher (20 degrees) initial curve presentations.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.