Juvenile Scoliosis

Bracing

Figure 1: Front and back views of a child in a cast
for scoliosis.

A few centers treat children with a body cast as a form of a brace (Figure 1). 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 underarm 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 Wilmington brace is a custom-molded thoracolumbosacral orthosis that has molds to push and correct the curve (Figure 2). The Boston brace is similar, but uses pads inside the brace to push the curve (Figure 3). The Milwaukee brace, one of the first braces developed for scoliosis treatment, is less popular today due to its design. Your doctor will probably recommend that your child wear the brace fulltime. Some lumbar and thoracolumbar curves will be treated by a part time or night time brace. The Charleston and Providence braces are prescribed for eight to twelve hour a day year at home. 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.


Figure 2: Back view of young girl in Wilmington brace.	Figure 3: Side-view of patient in a Boston brace.	Figure 4: Front view of a child in Milwaukee brace.

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.

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