Scoliosis is a sideways curvature of the spine, often appearing as a C or S shape. It most frequently develops in children and adolescents. While mild cases may not require active intervention, understanding when and how bracing can be a part of managing scoliosis is important for many families.
The Role of Bracing in Scoliosis Management
Bracing is a common non-surgical intervention for scoliosis, primarily used to prevent the spinal curve from worsening during periods of rapid growth. A brace stabilizes the spine and guides its growth, aiming to avoid surgical correction. It applies specific pressure to the outer edge of the spinal curve, influencing the spine’s development into a straighter position.
Determining the Need for Bracing
Decisions regarding bracing are based on several factors, with the magnitude of the curve being a primary consideration. Physicians typically consider bracing when the spinal curvature, measured as a Cobb angle, falls within a range of about 20 to 45 degrees. Bracing is often recommended for curves of 25 degrees or more in growing individuals. If a curve progresses beyond approximately 50 degrees, surgical intervention is more likely to be considered because curves of this severity can continue to worsen even after growth has finished.
Skeletal maturity plays a significant role in determining bracing effectiveness, as braces work best while the spine is still growing. Indicators of remaining growth include chronological age, especially in adolescents, and the Risser sign, which is assessed through X-rays to gauge bone development. For girls, the onset of menstruation (menarche) and the time elapsed since it began are also considered, with bracing being most impactful before or within a couple of years post-menarche. A lack of height gain over a six-month period can signal that a patient is nearing the end of their growth.
Evidence of curve progression is another important factor. Regular X-rays help healthcare providers track the curve’s changes. Bracing is most commonly applied for adolescent idiopathic scoliosis (AIS), the most common type, which typically develops during puberty. While other scoliosis types exist, such as congenital or neuromuscular, they often have different management considerations.
Types of Scoliosis Braces
Several types of braces are used in scoliosis management, each designed to address specific needs and wear schedules. The Boston brace, a type of thoracolumbosacral orthosis (TLSO), is the most frequently prescribed rigid brace. This brace is custom-fitted to the individual’s torso, extending from the armpits to the hips, and is typically worn under clothing. It functions by applying corrective pressure through strategically placed pads on the convex side of the curve, encouraging the spine to move into a straighter position.
Nighttime braces, such as the Charleston Bending Brace or Providence brace, offer an alternative for certain curve patterns. These braces are worn only during sleep, typically for 8-10 hours nightly. They apply a hypercorrective force to the spine, feasible due to the patient being in a reclined position. Nighttime braces are often considered for specific curve types, such as single curves under 35 degrees.
Living with a Scoliosis Brace
Adhering to the prescribed wear schedule is important for bracing effectiveness. For full-time braces, this typically means wearing it for 16 to 23 hours per day, with brief periods off for personal hygiene and certain physical activities. Nighttime braces are worn exclusively during sleep. It may take some time to adjust to wearing a brace, but many patients find it becomes more comfortable with consistent use.
Maintaining skin health under the brace is important. Daily bathing is recommended, and a clean, seamless, 100% cotton undershirt should always be worn beneath the brace. Applying rubbing alcohol to the skin can help toughen it, and it is important to regularly check for any red spots or irritation. Lotions or powders should generally be avoided under the brace as they can soften the skin and lead to issues.
Most physical activities and sports are possible while wearing a brace. Patients can typically remove the brace for sports or showering. Staying active is encouraged for overall well-being. Emotionally, adjusting to a brace can be challenging, but openly discussing their experience with friends and family can provide support. Bracing treatment generally continues until the patient reaches skeletal maturity, which can span several years.
Monitoring and Long-Term Outlook
Regular monitoring is an ongoing part of scoliosis bracing. This includes routine follow-up appointments with healthcare providers, often every four to six months, to assess the brace’s fit and effectiveness. X-rays are typically taken periodically to track the spinal curve’s progression and ensure the brace performs as intended. These evaluations help determine if any adjustments are needed.
Brace wear is discontinued once a patient reaches skeletal maturity. Criteria often include reaching a specific Risser sign stage (e.g., Risser 4 or 5), having no further increase in height over a six-month period, and, for girls, being at least two years past menarche. Sometimes, a gradual reduction in brace wear, known as weaning, is recommended before complete cessation.
The primary outcome of successful bracing is to prevent the spinal curve from worsening and avoid surgery. While bracing primarily aims to halt progression, some patients may experience a reduction in their existing curve. Preventing the curve from reaching surgical thresholds, such as 50 degrees, is a significant achievement of bracing. It is important to note that some patients may still experience a degree of curve progression after bracing is discontinued.