Scoliosis - Managing Scoliosis

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The brace needs to be worn 23 hours a day, with relief during bathing and exercise only. Compliance is a major problem. In one study, only 15% of patients wore the Milwaukee brace as directed. It is a particularly difficult brace to endure wearing, especially during adolescence, where it may lead to social problems with one's peers.

Thoracolumbar-Sacral Orthoses (TLSO). Molded braces called thoracolumbar-sacral orthoses (TLSOs), most often the Boston brace, come up to beneath the underarms and can be fitted close to the skin so they do not show beneath clothing. It appears to be effective for mid-back and lower curves. The risk for curve progression is significantly higher the less time the brace is worn. These braces have several problems: they are hot, reduce lung capacity by nearly 20%, and cause mild, temporary changes in kidney function.

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Nighttime Braces. The Charleston Bending brace and the Rosenberg brace are worn only at night. Some doctors question their value, although they appear to be suitable for small, flexible curves. Still, more than 10% of the patients using either the Boston brace or nighttime braces eventually needed surgery.

Newer braces are being developed in an attempt to improve compliance and results. Some examples are:

• The Providence brace is a computer-fitted device that is worn only at night. It is specifically designed for the individual curvature abnormalities, and early studies are showing promise.
• A bracing method called the SpineCor uses adjustable bands and a cotton vest that allows flexibility.
• The custom-fitted TriaC brace exerts pressure in specific areas of the back to allow greater comfort and flexibility. It may be less conspicuous than some of the older braces.

Studies are needed to determine if these or other new braces provide any additional value over existing ones.

Braces and Quality of Life

Compliance in wearing the brace varies widely. Patients are more likely to wear them at night but often wear them sporadically during the day. Quality of life can vary by the type of brace worn. In one study, patients who had the Milwaukee brace reported greater impairment than patients with the Boston, other TSLO, or Charleston braces. The choice of brace should be one that will be the most effective for a particular patient with the lowest impact on the patient's quality of life. Young people often refuse to wear braces, even the newer models, and emotional support from family and professionals is extremely important to help a child accept the process and stay compliant.

Exercise and Physical Therapy While Wearing Braces

For children who need braces, an exercise program helps boost well-being, improves compliance with treatment, and keeps muscles in tone so that the transition period after brace removal is easier.

An exercise and physical therapy program is important to maintain or achieve the following: