Idiopathic Scoliosis

Infantile

Casting / Bracing

Front and back views of a child in a cast for scoliosis.

Figure 1: Casting

If the curve is progressive, your doctor may want to place your child in a cast or brace. This is contingent upon the flexibility of the curve as determined by the bending radiographs. Rarely does a brace permanently correct scoliosis. Instead, the goal is to allow the child to grow before a more definitive procedure (surgery) is done. It must be re-emphasized that the purpose of the brace is to slow the inevitable progression of the curve, not to permanently correct the curve.

Casting
Due to their size, small children often respond better to casting – converting to bracing when their torso is large enough (see Figure 1). Placement of the cast on the child may require general anesthesia to increase flexibility of the curve and make the child more confortable during the application. The case is generally changed every six months . Casting can offer superior curve management at the cost of its inconvenience (it cannot be removed for bathing).

Bracing
The brace that your doctor prescribes may depend on your child’s age and the center you visit. The Kalabas brace has several straps that are applied over the shoulder and bend the child in the opposite direction of the curve (Figure 2A). The Wilmington brace is a custom-molded thoracolumbar orthosis that molds to push and correct the curve (Figure 2B-C). The Boston brace is similar, but uses pads inside the brace to push the curve. This is the most common used in older children and adolescents (Figure 2D). The Milwaukee brace, one of the first braces developed for scoliosis treatment, is rarely used today due to its design, which can include an extension to the chin (Figure 2E). Your doctor will probably recommend that your child wear the brace full time. Braces are generally removed for bathing and special occasions. As your child grows, new braces will need to be made, approximately every 12-18 months.

Bracing

Figure 2: A) The Kalabas non-rigid brace designed for small children. B & C) The Willmington brace using straps for support. C) demonstrates how the brace can be modified if necessary – in this case for a colostomy bag. D) The under-arm Boston brace – the most common brace used in older children. E) The Milwaukee brace with chin attachment (rarely used today).

Bracing may not be effective in every child for various reasons. If the curve is rigid, or the apex (midpoint) is too high (above the level of the armpits), bracing will do little good. Braces also have a more difficult time controlling kyphosis (round back) and lordosis (sway back). Since most braces work on the curve via pressure on the rib cage, concern exists over the effect that the brace has on the rib cage and subsequent development of the lungs. Children with reflux, feeding tubes, and colostomies may have difficulty wearing a brace, but modifications can usually be made (Figure 2C).

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