Brace (orthotic) treatment for scoliosis is used to prevent spinal curve progression and to maintain a more normal appearance of the back.
The goal of brace treatment is to prevent the curve from getting worse. Bracing does not correct a curve. There may be some initial straightening of the spine and the appearance of correction when a brace is applied. But in most cases, after the child stops wearing the brace, this correction is lost and the curve returns to its original shape.
What To Expect
In most cases, any correction of the curve that occurred during bracing is lost, and the curve returns to its original shape after bracing is discontinued.
Why It Is Done
Brace treatment is used for a child who is still growing to prevent progression of moderate spinal curves. Brace treatment is usually continued until the child's skeleton stops growing.
Two common types of braces include the:
- CTLSO, which stands for cervical-thoracic-lumbar-sacral orthosis. This brace consists of a customized pelvic girdle and a metal structure that extends to the neck. This brace is not hidden by clothing. The CTLSO is used to treat curves high in the upper back, such as kyphosis (hunchback). The brace treatment of kyphosis in the upper back can often result in correction.
- TLSO, which stands for thoracic-lumbar-sacral orthosis. This brace consists of a trunk and pelvic girdle that is customized to fit the child. It is used to treat curves in the mid back and lower back. This brace does not have a metal structure and can be hidden by clothing better than the CTLSO can be.
Braces are not effective for curves greater than 45 degrees.
How Well It Works
Most research on using braces for scoliosis has focused on idiopathic scoliosis. In general, the research shows that braces can be effective for preventing curves from getting worse. The more the child wears the brace, the more effective the brace can be.
Braces are generally effective in providing immediate control of curves. When a brace is first applied, a significant correction is often seen. But after the child stops wearing the brace, the curve usually returns.
Although bracing does not always prevent a spinal curve from getting worse, the best results occur when:
- Bracing is started early, while the child is still growing.
- The spinal curve is moderate, not severe.
- The brace is well fitted.
- The child wears the brace for the prescribed amount of time.
- There is family support for the child.
Complications of bracing therapy include:
- A child not wearing a brace for the prescribed amount of time, which allows the curve to get worse.
- Skin irritation.
What To Think About
Children who wear braces are examined by a doctor regularly (such as every 3 months or 6 months or more frequently if problems arise) to monitor the effects of the brace.
A child who has a severe forward curve in his or her upper back in addition to scoliosis may not be well suited for bracing.
Children can ride a bicycle, play tennis, run, and jump while wearing a brace. But they should not participate in activities such as horseback riding, skiing, skating, and gymnastics while wearing a brace. Because wearing a brace makes many physical activities difficult, children or teens are typically advised to remove their braces when they participate in activities such as physical education classes.
Other Works Consulted
- Negrini S, et al. (2015). Braces for idiopathic scoliosis in adolescents (Review). Cochrane Database of Systematic Reviews (6). DOI: 10.1002/14651858.CD006850.pub3. Accessed July 10, 2015.
- Rowe DE, et al. (2002, updated 2014). SRS bracing manual. Scoliosis Research Society. http://www.srs.org/professionals/online-education-and-resources/srs-bracing-manual. Accessed January 29, 2016.
- Spiegel DA, Dormans JP (2011). Idiopathic scoliosis. In RM Kliegman et al., eds., Nelson Textbook of Pediatrics, 19th ed., pp. 2365–2368. Philadelphia: Saunders.
- Weinstein SL, et al. (2013). Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine, 369(16): 1512–1521.