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Spine (Phila Pa 1976). 2013 Mar 1;38(5):E299-305. doi: 10.1097/BRS.0b013e318281dba6.

Effectiveness of brace treatment of Chiari malformation-associated scoliosis after posterior fossa decompression: a comparison with idiopathic scoliosis.

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  • 1Department of Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China.

Abstract

STUDY DESIGN:

Retrospective case-control study.

OBJECTIVE:

To evaluate the effectiveness of bracing in patients with Chiari malformation-associated scoliosis (CMS) after posterior fossa decompression (PFD).

SUMMARY OF BACKGROUND DATA:

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.

CONCLUSION:

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.

LEVEL OF EVIDENCE:

3.

PMID:
23238491
[PubMed - indexed for MEDLINE]
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