title: Effect of bracing on paralytic scoliosis secondary to spinal cord injury.
abstract: 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 < 10 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 (P < 0.001). There was no significant difference between time to surgery for the braced and nonbraced patient groups at higher (> 20 degrees) initial curve presentations.
  
  
  CONCLUSIONS
  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.
authors.affiliation: University of Pennsylvania Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Mehta
authors.forename: Randal R
authors.initials: RR
authors.lastname: Betz
authors.forename: M J
authors.initials: MJ
authors.lastname: Mulcahey
authors.forename: Craig
authors.initials: C
authors.lastname: McDonald
authors.forename: Lawrence C
authors.initials: LC
authors.lastname: Vogel
authors.forename: Caroline
authors.initials: C
authors.lastname: Anderson
mesh_terms: D017668:Age of Onset; D001915:Braces; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010243:Paralysis / Q000150:complications*; D012189:Retrospective Studies; D012600:Scoliosis / Q000209:etiology* / Q000628:therapy*; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000150:complications*; D016896:Treatment Outcome