Paralytic spinal deformity: Orthotic treatment in spinal discontinuity syndromes

Nineteen patients with spinal discontinuity syndromes resulting in paralytic spinal deformity were treated with orthoses to postpone spinal stabilization to allow for vertebral growth. All patients had some degree of sensory deficit under the orthosis. The average period of orthotic treatment for all patients was 54 months (range, 22 to 98). The initial upright curve measurement prior to treatment averaged 43°, the best correction obtained during treatment averaged 26°, and all curves averaged 39° when the brace was discontinued or at most recent follow-up. Although pressure sores occurred, no orthosis was abandoned due to a decubitus problem. Eight patients were successfully braced until maturity, at which time they underwent one stage spinal fusion. Five immature patients are still under active orthotic treatment. Poor compliance with brace wear was documented in the cases in which unacceptable progression occurred, requiring spinal fusion prior to maturity. Successful, technically simpler, one stage stabilization procedures were made possible by the successful long-term control of these difficult spinal deformities afforded by orthotic treatment.