Understanding Scoliosis and Brace Purpose
Scoliosis describes a condition where the spine develops a sideways curvature, often resembling an “S” or “C” shape. This curvature also involves a three-dimensional twisting of the vertebrae. While scoliosis can emerge at any age, it is most frequently identified in children and adolescents, particularly during periods of rapid growth. The most common form, adolescent idiopathic scoliosis, has no known cause.
For individuals still growing, the primary goal of bracing is to prevent the spinal curve from worsening. Braces are generally recommended for moderate curves, often between 20 and 45 degrees, to stabilize the spine. The aim is to halt curve progression and reduce the likelihood of needing surgical intervention. Bracing does not typically correct or reverse existing severe curves; instead, it works to maintain the current alignment and prevent further progression.
How Braces Work and Types Used
Back braces function by applying continuous pressure to the spine and ribs, which helps guide spinal growth and prevent further curvature. This pressure aims to maintain proper alignment during skeletal development. The brace works by pushing against the curve, influencing the spine’s growth and preventing it from becoming more pronounced.
One common type is the Thoraco-Lumbo-Sacral Orthosis (TLSO), like the Boston brace. This rigid plastic shell is custom-molded to fit the torso and is typically worn discreetly under clothing. It employs a three-point pressure system, applying corrective force to the convex side of the curve while incorporating relief areas on the opposite side to encourage spinal shift.
Another category includes nighttime braces, such as the Providence or Charleston Bending Brace. These are designed to be worn only during sleep and can apply more aggressive corrective pressure. Nighttime braces capitalize on the body’s relaxed state during sleep to facilitate curve correction, often by moving the spine towards or beyond the midline. The specific type of brace chosen depends on factors such as the curve’s location, its severity, and the remaining growth of the individual.
Effectiveness of Bracing
Bracing has demonstrated effectiveness in preventing the progression of spinal curves and reducing the need for surgery in appropriately selected individuals. Evidence from studies indicates that bracing can significantly lower the chances of a curve worsening to the point of requiring surgical intervention. A notable study, the Bracing in Adolescent Idiopathic Scoliosis Trial (BRAIST), found that 72% of brace wearers avoided surgical recommendations, compared to 48% in an observation-only group. This study was stopped early due to the clear benefits observed in the bracing group.
Consistent brace use, known as adherence, significantly influences treatment success. Individuals who wear their brace for the prescribed number of hours, often 18 hours per day, experience better outcomes. Studies suggest that wearing a brace for 13 hours or more daily can lead to success rates exceeding 90%. While bracing is a beneficial intervention, it does not guarantee a complete reversal of the curve, and some curves may still progress despite consistent brace wear. The measure of success often involves preventing the curve from reaching a threshold, typically 50 degrees, where surgery is usually considered.
Life with a Back Brace and Other Considerations
Full-time braces typically require wearing for 16 to 23 hours per day, with brief periods off for hygiene and activities. Maintaining skin health underneath the brace is important, often involving wearing a thin, snug-fitting undershirt and proper skin care. Loose-fitting clothing is often preferred to accommodate the brace and ensure comfort. Most physical activities are still possible while wearing a brace, and gradually increasing wear time helps in adaptation.
Wearing a brace can present emotional and social challenges, particularly for adolescents. Concerns about appearance, peer perception, and feeling different can lead to self-consciousness, frustration, or feelings of isolation. Girls may experience a greater emotional impact in some cases. Establishing strong support systems, including open communication with family and friends, can help individuals navigate these aspects.
Other management approaches for scoliosis exist. Very mild curves may only require observation and regular monitoring. Physical therapy and specific exercises can serve as complementary treatments, aiding in muscle strengthening and postural awareness. For severe, progressive curves, or instances where bracing has not been sufficient, spinal fusion surgery remains an option. Surgery is typically considered when curves reach 50 degrees or more.