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 o f spinal orthosis in 86 patients with spastic quadriplegic cerebral palsy w as performed. The mean age of the patients was 13.8 years (range 5 to 33 ye ars). Their scoliotic deformities were treated with custom-moulded, polypro pylene thoraco-lumbar-sacral orthoses, Cobb angles were measured on radiogr aphs 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 de grees), The mean correction in orthosis was 25 degrees (range 3 to 60 degre es). Seventy-two patients had a follow-up period of more than 2 years. At t he latest follow-up, average 6.3 years (range 2 to 14 years) after the star t of treatment, the mean Cobb angle without orthosis was 93.1 degrees (rang e 40 to 145 degrees), The mean progression per gear 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 influence d the rate of progression Twenty-two patients had no progression or progres sion <1.0 degrees per gear. Correction in orthosis was the only variable th at predicted progression <1.0 degrees per year in both age groups (<15 year s and greater than or equal to 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 th e use of orthosis, mainly because of improved sitting stability which gave better overall function.