Treatment of scoliosis with spinal bracing in quadriplegic cerebral palsy.
To evaluate the clinical results of the treatment and to assess the factors that influenced the rate of scoliosis progression, a retrospective study of spinal orthosis in 86 patients with spastic quadriplegic cerebral palsy was performed. The mean age of the patients was 13.8 years (range 5 to 33 years). Their scoliotic deformities were treated with custom-moulded, polypropylene thoraco-lumbar-sacral orthoses. Cobb angles were measured on radiographs taken in a sitting position before treatment, in orthosis, and during follow-up. The mean initial Cobb angle was 68.4 degrees (range 25 to 131 degrees). The mean correction in orthosis was 25 degrees (range 3 to 60 degrees). Seventy-two patients had a follow-up period of more than 2 years. At the latest follow-up, average 6.3 years (range 2 to 14 years) after the start of treatment, the mean Cobb angle without orthosis was 93.1 degrees (range 40 to 145 degrees). The mean progression per year was 4.2 degrees (range -3 to 21 degrees). Linear multiple regression revealed that age and initial correction in orthosis were the only variables that significantly influenced the rate of progression. Twenty-two patients had no progression or progression <1.0 degrees per year. Correction in orthosis was the only variable that predicted progression <1.0 degrees per year in both age groups (<15 years and > or =15 years). Of the 57 patients who were still alive and had not undergone surgical fusion, 72% used their orthoses at a mean age of 22 years. Parents and caregivers expressed satisfaction with the use of orthosis, mainly because of improved sitting stability which gave better overall function.
Terjesen
T
T
Department of Orthopaedic Surgery, The National Hospital, Oslo, Norway.
Lange
J E
JE
Steen
H
H
D000293:Adolescent; D000328:Adult; D001915:Braces; D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011782:Quadriplegia / Q000150:complications; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology / Q000628:therapy*; D016896:Treatment Outcome