Effect of bracing on paralytic scoliosis secondary to spinal cord injury

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 <10degrees, 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 11degrees and 20degrees (P < 0.001). There was no significant difference between time to surgery for the braced and nonbraced patient groups at higher (>20degrees) initial curve presentations. Conclusion: Bracing of children with SCI before significant curve formation (<20degrees) delays the time to surgical correction of the deformity as it progresses. At smaller curves (<10degrees), bracing may even prevent the need for surgery. As curve size increases (greater than or equal to20degrees), bracing seems to play a limited role, because it does not seem to prevent surgery or delay time to surgical correction.