Scoliosis is a condition characterized by an abnormal lateral, or sideways, curvature of the spine, often accompanied by a rotation of the vertebrae. The most common form is Adolescent Idiopathic Scoliosis (AIS), which appears in children and teenagers during their growth years. A scoliosis brace is a non-invasive orthopedic device frequently prescribed as a primary treatment for growing adolescents diagnosed with this condition. This external support is designed to manage the progression of the spinal curve without resorting to surgery.
The Purpose and Function of Bracing
The primary goal of bracing is to prevent the spinal curve from worsening while the adolescent is still growing. The brace stabilizes the spine and holds the curve in its present position, as it is not intended to significantly reverse the existing curvature. This intervention is particularly important during periods of rapid growth, when the curve is most likely to progress.
Bracing works by applying targeted external forces to the convex side of the spinal curve, often through strategically placed pressure pads. These forces push the spine back toward the midline, counteracting the curve’s tendency to increase. This three-point pressure system influences the growth plates of the vertebrae, guiding the spine into a straighter alignment over time.
Orthopedic specialists recommend bracing for growing patients whose spinal curve, measured as a Cobb angle, falls between 25 and 40 degrees. If the curve is less than 25 degrees, observation is sufficient, and if it progresses beyond 50 degrees, surgery may be required. The success of bracing is measured by preventing the curve from reaching the surgical threshold by the time the patient achieves skeletal maturity.
Key Types of Scoliosis Braces
The most widely prescribed type is the Thoraco-Lumbo-Sacral Orthosis (TLSO), often exemplified by the Boston Brace. This brace is a low-profile, rigid plastic shell that extends from below the breast down to the hips, fitting snugly around the torso and is typically worn underneath clothing. The Boston Brace applies corrective pressure in the lumbar and lower thoracic regions and is usually prescribed for a near full-time wearing schedule, often 18 to 23 hours per day.
Another category includes nighttime braces, designed to be worn only while sleeping, typically for 8 to 10 hours. The Charleston Bending Brace is a common example, custom-molded while the patient is bent to the side. This allows it to apply a hyper-corrective force that achieves a greater degree of pressure because the patient is lying down and not subject to the forces of gravity.
Newer, more dynamic designs aim for three-dimensional correction, addressing both the sideways curve and the rotational component of scoliosis. Braces like the Rigo-Cheneau style are custom-made using CAD/CAM technology based on a patient’s specific curve pattern. These devices incorporate expansion areas, encouraging the patient to breathe into the concavities of the curve, which aids in postural and rotational correction.
The Bracing Schedule and Daily Life
Adherence to the prescribed wearing schedule is paramount for the brace to be effective, with full-time wear often defined as 16 to 23 hours a day. Non-compliance significantly increases the risk that the spinal curve will continue to progress. Patients are advised to gradually increase their wearing time over the first few weeks to allow the body to adjust to the constant pressure.
Maintaining skin health is a practical consideration to prevent irritation beneath the brace. This requires wearing a seamless, cotton or specialized synthetic garment underneath at all times. The skin must be kept clean and dry, and the use of lotions or powders directly before wearing the brace is discouraged as they can increase the risk of skin breakdown.
Patients are encouraged to remove the brace for physical activity and sports, allowing for full range of motion during exercise. Regular movement is important for maintaining muscle strength and overall physical health. The orthopedic team monitors progress through regular clinical appointments and X-rays to assess the curve’s stability and make necessary adjustments to the brace fit or the wearing schedule.