Brace (orthotic) treatment for scoliosis

Treatment Overview

Brace (orthotic) treatment for scoliosis is used to prevent spinal curve progression and to maintain the 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. However in most cases, once the bracing program has ended, this correction is lost and the curve returns to its original degree.

What To Expect After Treatment

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 spinal curves between 25 and 40 degrees. Some doctors may use brace treatment for curves up to 45 degrees. Brace treatment is usually continued until the child's skeleton stops growing.

Two common types of braces include the:

• Milwaukee brace, which consists of a customized pelvic girdle and a metal structure that extends to the neck. This brace is not hidden by clothing. The Milwaukee brace 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.
• Thoracolumbosacral orthosis (TLSO), which is a brace consisting of a trunk and pelvic girdle that is customized to fit the person. It is used to treat mid and lower back curves. This brace does not have a metal structure and can be hidden better by clothing than the Milwaukee brace.

Braces are not effective for curves larger than 45 degrees.

How Well It Works

Braces are generally effective in providing immediate control of curves. When a brace is first applied, a significant correction is often seen. However, once bracing is stopped, the curve usually returns.

The Milwaukee brace is effective in preventing further progression of spinal curves.¹ However, children often do not wear the brace as prescribed because it has to be worn a long time—often 23 hours a day—and because the child may be embarrassed by its appearance.

The TLSO is now most commonly used because it is effective in preventing a spinal curve from getting worse, and it is easier to use because it can be hidden by clothes.

Although bracing may not always be effective in preventing a spinal curve from getting worse, the best results occur when:

• Bracing is started early, while a child is still growing.
• The spinal curve is between 25 and 40 degrees. Some doctors may use brace treatment for curves up to 45 degrees.
• The brace is well fitted.
• The child wears the brace for the prescribed amount of time.
• There is family support for the child.

Risks

Complications of bracing therapy include:

• A child not wearing a brace for the prescribed amount of time, which allows the curve to worsen.
• Skin irritation.
• Discomfort.

What To Think About

People who wear braces are examined regularly (such as at 3 months or 6 months or more frequently if problems arise) to monitor the effects of the brace.

A young person with a severe forward curve in the upper back in addition to scoliosis may not be well suited for bracing.

You can ride bicycles, play tennis, run, and jump while wearing a brace. However, do not participate in activities such as horseback riding, skiing, skating, and gymnastics while wearing a brace. Since a brace makes many physical activities difficult, children or teens are generally advised to remove their brace to allow participation in activities such as physical education classes.

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Author:	Alison Allen Kathe Gallagher, MSW	Last Updated: October 25, 2007
Medical Review:	Michael J. Sexton, MD - Pediatrics Thomas S. Renshaw, MD - Orthopedics Andrew Swan, MD, CCFP, FCFP - Family Medicine
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