Juvenile Idiopathic Scoliosis - Bracing - Scoliosis Research Society (SRS)

Bracing

If the curve is progressive, your doctor may want to place your child in a 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.

The brace that your doctor prescribes may depend on your child’s age and the center you visit. The Wilmington brace is a custom-molded thoracolumbar orthosis that molds to push and correct the curve (Figure 1 A and B). The SpineCore brace uses straps to straighten the curve (Figure 1 C and D). The Boston brace is similar to the Wilmington bract, but uses pads inside the brace to push the curve. This is the most common used in older children and adolescents (Figure 1 E and F). The Providence brace uses carbon fiber reinforcements to derotate the spine (Figure 1 G and H). 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 1I). 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 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.

Bracing

Figure 1A-I:

Video Library
Videos Prepared by Paul Sponseller, MD and Kristin Venuti of the Pediatric Spine Service at The John Hopkins University

Nora's Story

TLSO Brace for Scoliosis

Nora is 14 years old. She wears a custom TLSO brace for scoliosis. Nora doesn't hide the brace, in fact, her friends have decorated it! She faithfully wears it all day, but she does take it off for field hockey. Prebrace, Nora had a 33 degree thoracic curve and a 40 degree lumbar curve. After eight months her curves are not increasing - the thoracic curve is 33 degrees and the lumbar curve is 35 degrees.

Joshua's Story

Milwaukee Brace for Kyphosis

Joshua is 14 years old. He wears a Milwaukee brace for kyphosis. He is motivated by the opportunity to avoid surgery. His kyphosis curve measured 71 degrees prebrace. After only 6 months it's been reduced to 49 degrees. A Boy Scout, Joshua is committed to the brace. He even wears it camping and hiking.

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