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.
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.