Scoliosis - Managing Scoliosis

Braces and Other Noninvasive Treatments

Braces are generally prescribed to prevent further progression of curves that are at least 25 degrees, and no more than 40 degrees. Patients should have documented progression of the curve, and the child should still be growing.

Results vary widely depending on the length of time the brace is worn, the type of brace, and the severity of the curve. Determining how effective braces are has been difficult for researchers. Most studies evaluate whether the curve has progressed. There is much less information about whether brace usage actually reduces the number of patients who eventually have surgery.

---

---

The great majority of subjects in scoliosis studies are girls. Limited data suggest that in boys compliance rates are low, and braces are not effective. However, compliance with wearing a brace correlates strongly with success rate.

In overweight patients with adolescent idiopathic scoliosis, braces appear to be less effective than in those who are not overweight.

Many experts have questioned whether a brace is any better than nature in halting curvature progress. Early studies found that braces were successful in halting progression in only half of cases (the same rate as no treatment at all). In recent years, however, braces have improved. Many now fit under the arms and can be worn under clothing, so that patients are much more likely to use them for longer periods during the day, which greatly affects their success rates.

Team Approach

Wearing the brace for the prescribed time is difficult but essential for any success. A team approach, with several health professionals involved, is beneficial and often necessary to support the patient through the bracing process. An orthopedic surgeon interprets the x-rays, assesses the potential progression of the scoliosis, and plans the treatment with the patient and family. If a brace is used, an orthotist measures and fits the patient with the device. A physical therapist tailors an exercise program best suited for the patient. A nurse may also coordinate the treatment plans and provide physical and emotional support.

Types of Braces

Full Torso Brace. A full torso brace called the Milwaukee brace was the standard treatment until a decade ago. It is still used particularly for high curves.

The device contains a wide flat bar in front and two smaller ones in back. These bars attach to a ring around the neck that has rests for the chin and back of the head. The best curve correction may occur if the patient lies on their chest when wearing the brace. Some researchers suggest that increasing the tension on the chest straps might add benefit. The brace is also periodically adjusted for growth.