Use of Spinal Orthoses in the Treatment of Scoliosis in Cerebral Palsy
SEYMOUR ZIMBLER, MD**, CLIFFORD L. CRAIG, MD,ROGER SOHN, MD, AND GERRY ROSENBERG, MD Boston, Massachusetts
0f 300 spastic quadriplegic patients followed at our clinic, 68 have been treated for structural scoliosis for at least one year (average three years). Treatment began when structural curves of greater than 20 degrees were noted. Orthoses included ten Milwaukee braces and a variety of total contact underarm plastic braces. The goals of therapy are to: 1) minimize spinal deformity; 2) improve and/or maintain sitting balance; 3) prevent loss of upper-limb function because of decompensation and pelvic obliquity; 4) decrease or stabilize nursing care needs; 5) prevent back pain, and 6) prevent cardiorespiratory decompensation.
Seven patients showed reduced curves. Twelve were maintained at the same degree of deformity. Twenty-six showed progressive scoliosis. Five underwent spine fusion. Eighteen did not use orthoses constantly enough to allow evaluation. This study confirms the predictable difficulty in stabilizing decompensated structural scoliosis greater than 40 degrees. Children under age 10 with less severe curves (under 40 degrees) may be the only candidates for spinal orthoses.
**Boston Floating Hospital, Tufts University School of Medicine, Department of Orthopedics, 171 Harrison Avenue, Boston, MA 02111