Scoliosis is a condition characterized by a sideways curvature of the spine, often appearing as an S- or C-shape. While the spine naturally has forward and backward curves, scoliosis involves an atypical side-to-side deviation. Most cases are mild and do not cause significant symptoms. However, for moderate to severe curvatures, especially in growing individuals, scoliosis bracing is a common non-surgical treatment option. The primary question for many is whether these braces are effective in managing spinal curves.
How Braces Influence Spinal Curvature
Scoliosis braces apply targeted external pressure to the spine. This pressure guides the growing spine into a straighter alignment and prevents the curve from worsening. The brace influences the growth of spinal bones.
Many braces utilize a “three-point pressure system.” This involves two pressure points pushing in one direction on the curve, with a third pushing back in the opposite direction. This application of force counteracts the spinal curvature. Some modern braces also incorporate de-rotational forces, addressing the three-dimensional nature of scoliosis, which involves sideways bending and twisting.
Criteria for Brace Treatment
Brace treatment is recommended for growing individuals with specific curve characteristics. Guidelines suggest bracing for curves measuring between 25 and 40 degrees by the Cobb angle. In younger patients, bracing might be considered for curves as small as 20 degrees, particularly with clear evidence of progression.
The patient’s remaining growth potential is an important factor. Braces are most effective in children and adolescents who are still growing, as treatment relies on influencing bone development. Indicators of growth potential include the Risser sign (a measure of bone maturity) and, for girls, their menarche status. Bracing is primarily used for adolescent idiopathic scoliosis, the most common type. The goal is to prevent the curve from progressing to a severity requiring surgical intervention.
Measuring Brace Success
The effectiveness of scoliosis bracing is measured by its ability to prevent spinal curve progression. Success is often defined as preventing the curve from increasing by 6 degrees or more, or from reaching a magnitude necessitating surgery, typically 50 degrees. Studies show bracing can prevent curve progression in a significant percentage of patients, with research indicating 70% prevented progression of 6 degrees or more.
A landmark study, the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST), demonstrated bracing is superior to observation in preventing curve progression and the need for surgery. This study found a 90% success rate in patients who wore their brace for 13 or more hours daily. Conversely, patients with low brace wear (0-6 hours per day) showed results similar to no treatment. Brace compliance is a significant factor in achieving positive outcomes; consistent wear leads to better results.
Daily Life with a Scoliosis Brace
Wearing a scoliosis brace requires commitment to a daily schedule. Patients are advised to wear their brace for 16 to 23 hours per day, with breaks for activities like showering or sports. This full-time wear is recommended during periods of rapid growth.
Adjusting to a brace presents practical and emotional challenges. Clothing choices may need to accommodate the brace, and maintaining hygiene requires routines. While physical activity is encouraged, some adjustments might be necessary. Many adolescents report feeling psychologically affected by wearing a brace, with concerns about body image and social acceptance. Despite these challenges, becoming accustomed to the brace over time can lead to improved psychological well-being.