title: Effectiveness of brace treatment of Chiari malformation-associated scoliosis after posterior fossa decompression: a comparison with idiopathic scoliosis.
abstract: METHODS
  Retrospective case-control study.
  
  
  OBJECTIVE
  To evaluate the effectiveness of bracing in patients with Chiari malformation-associated scoliosis (CMS) after posterior fossa decompression (PFD).
  
  
  BACKGROUND
  The effectiveness of bracing has been poorly studied in patients with CMS who have undergone PFD.
  
  
  METHODS
  A retrospective study was conducted on 22 patients with CMS who received brace treatment of scoliosis after PFD. Forty-four age- and sex-matched patients with idiopathic scoliosis (IS) who were treated with bracing served as the control group. The bracing outcome was considered a failure if the curve worsened 6° or more; otherwise, the treatment was considered to be successful.
  
  
  RESULTS
  The age and Risser sign were similar between patients with CMS and IS at brace initiation. The initial curve magnitude of patients with CMS (mean, 32.9° ± 6.3°; range, 20°-45°) was marginally significantly larger than that of patients with IS (mean, 29.6° ± 6.4°; range, 20°-45°). Until the final follow-up, a 6° or more worsening of the major curve occurred in 8 patients with CMS (36%) and in 15 patients with IS (34%). Overall, 7 patients with CMS (32%) and 13 patients with IS (30%) underwent spinal fusion surgery. No significant differences were observed between the 2 groups in the surgery rates or the bracing success rates (P > 0.05). In patients with CMS, neither the performance of syringosubarachnoid shunting nor the extent of tonsillar descent correlated with the bracing outcomes, whereas a double major curve pattern was found to be predictive for the failure of bracing.
  
  
  CONCLUSIONS
  Brace treatment subsequent to PFD is effective in preventing curve progression for 64% of patients with CMS, which is comparable with the rate that is observed in patients with IS. Double major curve pattern may be a risk factor in predicting treatment failure in patients with CMS.
  
  
  METHODS
  3.
authors.affiliation: Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.
authors.forename: Shifu
authors.initials: S
authors.lastname: Sha
authors.forename: Zezhang
authors.initials: Z
authors.lastname: Zhu
authors.forename: Xu
authors.initials: X
authors.lastname: Sun
authors.forename: Xin
authors.initials: X
authors.lastname: Zheng
authors.forename: Zhen
authors.initials: Z
authors.lastname: Liu
authors.forename: Tao
authors.initials: T
authors.lastname: Wu
authors.forename: Huang
authors.initials: H
authors.lastname: Yan
authors.forename: Yong
authors.initials: Y
authors.lastname: Qiu
mesh_terms: D000293:Adolescent; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D001915:Braces / Q000009:adverse effects; D016009:Chi-Square Distribution; D002648:Child; D003131:Combined Modality Therapy; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery / Q000628:therapy*; D013123:Spinal Fusion; D016896:Treatment Outcome