Scoliosis is a medical condition characterized by an abnormal, sideways curvature of the spine that often develops during the growth spurt just before puberty. This lateral spinal deviation, measured using a metric called the Cobb angle, typically requires intervention when it becomes moderate in severity. For adolescents with this condition, a spinal brace is the most common non-surgical treatment option recommended by medical professionals. This article explores the scientific evidence behind scoliosis bracing to clarify its purpose and effectiveness in managing the condition.
The Primary Goal and Effectiveness of Bracing
The Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST) demonstrated that bracing is an effective treatment for preventing the curve from worsening. It is a common misunderstanding that a brace will correct or reverse the existing curve, but its primary function is to halt the curve’s progression.
Treatment success is defined by avoiding spinal fusion surgery, which is typically recommended if the curve progresses past 50 degrees. The BrAIST study found that 72% of patients in the bracing group successfully reached skeletal maturity without their curve reaching the surgical threshold, compared to only 48% in the observation group. This substantial difference provides strong evidence that bracing is a highly effective intervention for managing curve progression. The mechanical pressure applied by the orthosis works to stabilize the spine during the period of rapid skeletal growth.
Patient Criteria for Brace Treatment
Bracing is reserved for patients who meet specific clinical requirements indicating a high risk of curve progression. The first criterion is the magnitude of the spinal curve, which must typically fall between 25 and 40 degrees as measured by the Cobb angle. Curves smaller than 25 degrees are usually monitored through observation, while those over 40 degrees may already be approaching the surgical range.
The second factor is the patient’s remaining skeletal growth potential. Braces are ineffective once a patient has finished growing, so treatment focuses on the adolescent growth spurt. Physicians assess skeletal maturity using tools like the Risser sign, a grading system based on the ossification of the pelvis. Bracing is most effective for patients with a Risser sign of 0 to 2.
Common Types of Braces and Their Wear Schedules
The effectiveness of bracing is tied directly to the type of orthosis used and the adherence to its prescribed wear schedule. The most common design is the rigid Thoracolumbosacral Orthosis (TLSO), often referred to as the Boston Brace. This brace is custom-molded to the patient’s torso and works by applying targeted pressure to push the spine back toward the midline.
The Boston Brace and similar rigid designs require full-time wear, generally defined as 18 or more hours per day, to maintain consistent pressure on the growing spine. Conversely, other designs, such as the Charleston Bending Brace, are prescribed for nighttime-only wear. This type of brace is designed to physically overcorrect the curve while the patient is lying down, utilizing the hours of sleep for intensive, short-duration treatment. The specific curve location and magnitude dictate whether a full-time or nighttime brace is appropriate.
Maximizing Success Through Compliance and Support
The success of bracing hinges on the patient’s adherence to the prescribed wear schedule. Scientific data has established a direct correlation between the number of hours a brace is worn and the probability of avoiding surgery. For instance, the BrAIST study indicated that wearing a brace for at least 13 hours per day was associated with success rates exceeding 90%.
Patients and their families need to develop routines that incorporate activities, physical education, and skincare around the brace wear. Maintaining skin integrity under the brace requires regular checks and cleaning to prevent breakdown from pressure and moisture. Emotional support is also a major factor, as the appearance and physical restriction of the brace can affect self-esteem and body image, making open communication with healthcare providers and support groups beneficial.