Scoliosis is a condition characterized by a sideways curvature of the spine, often appearing during adolescence. This curvature may progress as a child grows. Bracing is a common non-surgical treatment for adolescent idiopathic scoliosis, the most common type with no known cause. Its primary purpose is to prevent the spinal curve from worsening during rapid growth, aiming to avoid more invasive treatments like surgery.
Factors Determining Brace Wear
The duration an individual wears a scoliosis brace is influenced by several factors, primarily the patient’s growth potential. Skeletal maturity, a measure of how much growth remains, is a primary determinant. This is often assessed using the Risser sign, a grading system based on the ossification of the iliac crest visible on X-rays. A lower Risser score (e.g., Risser 0 or 1) indicates more remaining growth, suggesting a longer bracing period might be necessary to manage curve progression.
The severity of the spinal curve, measured by the Cobb angle, also plays a role in the decision to brace. Curves between 20 and 40 degrees in growing patients are considered for bracing. For example, a 30-degree curve in a 10-year-old with significant growth remaining would likely warrant bracing, while the same curve in a 16-year-old who has stopped growing might not require active treatment. Bracing is most commonly applied for adolescent idiopathic scoliosis, but less frequently for other types, such as congenital or neuromuscular scoliosis.
Different brace types also influence wear protocols. Full-time braces, like the Boston brace, are designed for near-constant wear, while others may be for nighttime use. The specific design, whether rigid or flexible, can affect comfort and the prescribed wear schedule. Ultimately, the decision on brace type and wear duration is individualized, based on these patient-specific variables.
Common Bracing Schedules
Bracing schedules vary, but full-time bracing involves wearing the brace for 18 to 23 hours per day. This continuous application of corrective pressure is considered the standard of care for many curves, with research indicating that more hours in the brace lead to better outcomes in preventing curve progression. The rationale behind such extensive daily wear is to consistently guide the spine’s growth, similar to how orthodontic braces straighten teeth over time.
Alternatively, nighttime bracing may be considered for smaller, stable curves in younger patients. While some recent studies suggest nighttime bracing can have an impact, it is not considered as effective as full-time wear, especially for children in their most rapid growth phases. Regardless of the daily schedule, the overall duration of bracing continues until skeletal maturity is reached, which can mean wearing a brace for several years, often ranging from two to five years or even longer, depending on the age at diagnosis and individual growth patterns.
Criteria for Ending Bracing
The decision to discontinue scoliosis bracing is made by healthcare providers based on several indicators of skeletal maturity and curve stability. A primary criterion is reaching full skeletal maturity, as assessed by the Risser scale. For girls, a Risser score of 4 or 5 indicates sufficient skeletal maturity, while for boys, a Risser 5 is considered the endpoint of significant growth. This means the bones have largely finished growing and fusing.
Another indicator is a plateau in height growth, specifically no increase in standing or sitting height over about six months. For girls, the time since menarche (the onset of menstruation) is also a factor, with bracing often continuing for 18 to 24 months post-menarche. The stability of the spinal curve is also considered; the curve should show no progression or remain stable for a certain period after skeletal maturity has been achieved. Ultimately, the treating physician makes the final decision to end bracing, often recommending a gradual reduction in brace wear over several months, a process known as weaning.
Importance of Adherence
Following the prescribed brace wear schedule is important for the success of scoliosis treatment. Compliance directly impacts the effectiveness of the treatment. A brace works by applying gentle, continuous pressure to the spine to prevent the curve from worsening as the child grows.
Not wearing the brace for the recommended number of hours can lead to the progression of the spinal curve. If the curve continues to worsen, it might eventually reach a degree that necessitates more invasive interventions, such as surgery. Consistent brace wear significantly increases the likelihood of preventing curve progression and achieving treatment goals, potentially avoiding surgery. The patient’s active role in adhering to the treatment plan is therefore a considerable factor in their journey.