Last Updated on December 15, 2023
Braces for scoliosis are recommended to prevent the scoliotic curve from getting worse. Many different types of braces are available now and can be used depending on the level, severity, and convenience of the person using them.
Some braces for scoliosis are worn full time whereas others are night time only. Braces are used in scoliosis when the curve is not so mild that it could be managed with observation or it is so severe that surgery is required.
Braces for scoliosis aim to prevent the curve from worsening. Most of the cases of idiopathic scoliosis belong to adolescent idiopathic scoliosis. This is the age when the adolescent growth spurt might worsen the curve. If required as guided by the severity of the curve, bracing can be used to prevent this worsening.
It is to be remembered that braces for scoliosis would not correct the existing scoliotic deformity, only prevent worsening.
When to Use Braces for Scoliosis
Scoliosis is a lateral curvature of the spine. Cobb’s angle is used to ascertain and categorize the scoliosis according to severity. A Cobb angle of more than 10 degrees is termed scoliosis. Between 10 and 25 degrees, observation and follow-up every 4-6 months is recommended. Bracing treatment is not required.
Bracing for scoliosis is considered when
- Cobb angle > 25 degrees and significant growth left till skeletal maturity
- Cobb angle < 25 degrees but rapid progression (>5 degrees in 4-6 months).
Bracing is not used if the adolescent is nearing his skeletal maturity.
A scoliosis brace will not improve the preexisting deformity. But wearing a brace can help to prevent the further worsening of the curve.
A curve that is 50 degrees or more by the time skeletal maturity arrives may keep on worsening in adulthood and surgical procedures would be needed. If the curve could be stopped from worsening, it saves the person from surgical procedures and associated risks and morbidities.
How Braces for Scoliosis Work
Scoliosis is a lateral curvature of the spine. One side is convex whereas the other side is concave.
Treatment of bracing aims to apply forces in such a way that the compression is increased on the convex side and decreased on the concave side. This is achieved by the special design of the braces. This is thought to allow the bones on the concave side to grow more [as they are less compressed] and those on the convex side grow less (more compression). This may in effect prevent the curve from getting worse.
Braces need to be worn till skeletal maturity only as after that bones will stop growing.
However, this is a theory, and the exact mechanism of how bracing works in scoliosis is being studied.
Different Types of Braces for Scoliosis
It has been reported that only hard braces are effective in scoliosis. There are two main groups of scoliosis braces
- Full-time braces: These braces for scoliosis need to be worn almost the whole day. As much as 23 hours in a given day
- Nighttime braces: These braces are to be used only during sleeping. Roughly about 8-10 hours
Full-time Braces for Scoliosis
Milwaukee brace for first full-time brace designed for scoliosis. It was cervical-thoracic-lumbosacral orthosis (CTLSO). The other braces in this category are mainly TLSO. Cervical component is not always given but can be added wherever needed. The cervical part of the orthosis is required only if the cure is high in thoracic area.
These braces (TLSO type) can be worn under the clothes and are commonly called ‘low-profile’ braces for scoliosis. They are also called as or underarm braces.
Boston Brace
Boston brace is the most commonly prescribed brace for scoliosis patients today. It is named after the institute – The Boston Children’s Hospital-where its inventors developed in the 1970s.
It is a type of thoracolumbosacral orthosis (TLSO) but neck extension can be added in case of high-degree curves located on the thoracic spine. . It is a small brace that can be worn under the clothes. the components are custom-made to fit better.
– Anteriorly, the Boston brace extent is from just below the breast and to the beginning of the pelvic region.
– Posteriorly, from below the scapula (shoulder blades) to the coccygeal (tail bone) region.
The brace applies corrective pressure on the convex side of the curve. The corresponding area on the concave side is cut to provide relief and to allow migration of the spine to that side.
The brace opens and closes from behind and help may be needed to get in or out of the brace.
Wilmington Brace
Wilmington brace is another TLSO used. It is entirely custom-fitted. A cast is taken for the measurement with the patient lying face up. Corrective forces specific to he patient’s spinal curve are added before the brace is completed.
It is similar to a jacket and is known as a full contact brace as it does not have gaps or cuts like a Boston brace.
Milwaukee Brace
This is the original cervico-thoracic-lumbar-sacral orthosis (CTLSO), which is now prescribed only to people with a high thoracic curve. This brace extends from the pelvis up to the neck. The brace is contoured over the pelvic girdle and metal bars extend in the front and back of the brace to connect with the neck ring.
These metal bars help the torso to extend while the neck ring keeps the head in a central position over the pelvis. The brace is aligned to the spinal curve of the person.
It is a bulkier brace and cannot be fully concealed under the clothes. Milwaukee brace is less commonly used in case of higher thoracic curves.
Nighttime Braces for Scoliosis
These braces are to be worn only during the night when the person sleeps. So the duration of wearing is about 8-10 hours. They are so designed to put greater force on the spine in a lying down position. Another advantage is that these do not need counterbalancing forces as in during walking so they can afford to apply greater forces. These braces for scoliosis ar more convenient to use because of reduced wearing time and the requirement of wearing is in private.
Charleston Brace
Also called the Charleston bending brace, it is most commonly used. It is custom-fitted and spine curve-based forces are added to the design depending on the individual curve.
Charleston brace pushes the spinal curve to the midline by applying lateral force. Moreover, it also applies pressure to bend and hold the spine in the overcorrected position.
This position is easier to hold and maintain at night when the person is lying.
Providence Brace
The Providence brace is similar in concept to the Charleston brace. It also overcorrects the spine. However, the difference is that instead of bending the curve in the opposite direction, one shoulder is slightly elevated to apply lateral and rotational forces.
Which Braces are Best for Scoliosis – Full-Time or Nighttime
Both have been proven to be effective treatment options but the conclusion is yet not arrived at.
Nighttime braces for scoliosis offer more convenience and freedom and hence better compliance. However, the time spent in nighttime braces appears to be less and it has been observed that the effect of the brace is proportional to the time spent in the brace.
But the evidence for that is not conclusive.
Our knowledge and decision-making will get better as we conduct more studies. Studies would also determine if soft braces are effective when compared to hard braces because hitherto the trend is only to prescribe hard braces and these braces can be uncomfortable.
Followup of Braces for Scoliosis
As the child grows, the brace may need to be replaced. So a brace may not last more than 4-6 months in a growing child.
The brace has to be worn as long as the child is growing.
A child with a brace for scoliosis should also undergo physical therapy. Though the exercises or therapy have no direct role in scoliosis correction or progression prevention, these are good for posture, flexibility, and muscle strength.
References
- Types of Scoliosis Braces – https://www.scoliosissos.com/blog/types-of-scoliosis-braces, accessed on 15/12/2023 [Link]
- Grivas, Theodoros & Rodopoulos, Georgios & Bardakos, Nikolaos. (2008). Night-time braces for treatment of Adolescent Idiopathic Scoliosis. Disability and rehabilitation. Assistive technology. May 2008, 3(3), 120-9. [Link]
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Schiller JR, Thakur NA, Eberson CP. Brace management in adolescent idiopathic scoliosis. Clin Orthop Relat Res. 2010 Mar;468(3):670-8.
Charleston brace- Image representation has been taken from Grivas et al article
