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 child stops wearing the brace, this correction is lost and the curve returns to its original shape.

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 that are 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 that 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 Milwaukee brace.

Braces are not effective for curves greater 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 the child stops wearing the brace, 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 nearly all the time-often 23 hours a day-and because the child may be embarrassed by how it looks.

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 worn under clothing.

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 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 get worse.
• Skin irritation.
• Discomfort.

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. However, 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 generally advised to remove their brace when they participate in activities such as physical education classes.

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Citations

1. Roach JW (1999). Adolescent idiopathic scoliosis. Orthopedic Clinics of North America, 30(3): 353–394.