Juvenile Scoliosis
Bracing
If the curve is progressive, and your child is still growing, the 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. If the curve is rigid and does not correct (get smaller) on the bending films, a brace will do little good. Rarely does a brace permanently correct scoliosis, instead the goal of bracing 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 correct the curve.
A few centers treat young children with a body cast (Figure 4). Placement of the cast on the child may require general anesthesia to increase flexibility of the curve and make the child more comfortable during the application. The cast is generally changed every six months, usually under an anesthetic. Casting can offer superior curve management, at the cost of its inconvenience (cannot be removed for bathing).
The brace that your doctor prescribes may depend on your child's age and the center you visit. There are several types of braces, they typically have the same success rates, but your doctor will select one based on his/her experience with the different devices. The Kalabas brace has several straps that are applied over the shoulder and bend the child in the opposite direction of the curve (Figure 5). The Wilmington brace is a custom-molded thoracolumbosacral orthosis that has molds to push and correct the curve (Figure 6). The Boston brace is similar, but uses pads inside the brace to push the curve (Figure 7). The Milwaukee brace, one of the first braces developed for scoliosis treatment, is less popular today due to its design, which can include an extension to the chin (Figure 8). It is the only brace, however, that can manage curves in the top part of the spine. Your doctor will probably recommend that your child wear the brace fulltime. Braces are generally removed for bathing and special occasions. As your child grows, new braces will need to be fabricated, approximately every twelve to eighteen months.
Braces may not be effective in every child for various reasons. The curve may be stiff and resistant to correction. Braces also have a more difficult time controlling kyphosis (round back) and lordosis (sway back). Since most braces work on the curve via the pressure they exert on the rib cage, concern exists over the effect that the brace has on the rib cage and the subsequent development of the lungs. Children with reflux, feeding tubes, and colostomies may have difficulty wearing a brace, but modifications can be made (Figure 9).
