The spine has natural sagittal curves, at all 3 regions of the spine, the cervical, thoracic, and sacral region.  These curves between the front and back of the body, provide flexibility, absorb and distribute stresses from regular activities such as walking, jumping, and running. However, some people may have an abnormal lateral curvature, causing the spine to curve side-to-side. This type of curvature is known as scoliosis.

Scoliosis is most often diagnosed in children and generally begins around the ages of 10-15. While it can occur equally in both genders, females are more likely to see a curvature that reaches a need for treatment.

The Symptoms of Scoliosis

When it comes to diagnosing scoliosis, a doctor will often look for the following symptoms:

– head is not centered above the pelvis
– shoulders are uneven
– waist is uneven
– rib cages at different heights
– one or both hips are unusually high
– whole body tilts to one side

The severity of these symptoms can determine which treatment will be the best option.

Treatment Options for Scoliosis

There are three general treatment options for scoliosis: observation, bracing, and surgery.

Observation is often considered in cases of scoliosis that are minor enough to not cause any problems. With observation, a doctor watches the child’s scoliosis and does not intervene until it reaches a certain point, which is typically a curve that is 25 degrees or more.

Surgery is generally considered only for cases of severe curvature that show signs of continuing to worsen. Degree-wise, surgery is considered when the curve exceeds 50 degrees.

For most cases of scoliosis in need of treatment, patients and their parents turn to bracing

Bracing for Scoliosis

Bracing for scoliosis involves wearing a brace that holds the spine in the correct alignment. It is effective in children since their spines continue to grow and mature, meaning the brace can impact their growth and correct any curves as the spine continues to mature.

Still, there are many different types of braces for scoliosis, so it is beneficial to work with an orthotist to find the best options for your child.

All scoliosis braces fall into two categories, which are distinguished by how often they are worn.

Full-Time Braces

These braces must be worn at all times and are most effective for those with curves at T8 (bottom of the shoulder blades) or lower. As a brace that is worn at all times, including when standing, the full-time brace must hold the head above the pelvis and remain comfortable enough to wear throughout the day and at night.

Boston Brace

The Boston brace is the most common brace utilized for treating scoliosis. It is a thoracic-lumbar-sacral orthosis (TLSO), although some models also contain a neck extension for cases of high curvature.

The Boston brace is custom fit from measurements or a cast. Trim lines and corrective pads are then added to the brace, to influence the curve development.
This brace type works by applying pressure to outward or convex side of the curve in the spine while having cutouts on the opposite side of the brace so that the spine naturally shifts in that direction.

Wilmington Brace

This brace is similar to the Boston brace, but it is a completely custom brace formed from a cast of a the body taken while laying down. Also, this brace does not utilize cutouts, making it a full-contact TLSO.

Milwaukee Brace

The Milwaukee brace is a cervico-thoraco-lumbo-sacral (CTLSO) brace. It is more involved than the Boston or Wilmington Brace and rarely used now. The design of this brace extends from the neck to the pelvis, and it includes a neck ring and pelvic girdle, which help to keep the head centered over the pelvis. Otherwise, it works similarly to the Boston brace by using strategically-placed pads to squeeze the spine into a corrective position.

Nighttime Braces

Compared to full-time braces, nighttime braces are only intended to be worn while lying down, which means they can apply stronger forces to the spine and are not restricted by the head’s need to remain over the pelvis.

During the day, the head must remain above the pelvis, but this is not necessary for braces only worn at night. As such, nighttime braces often treat scoliosis by overcorrecting the spinal curve, and while this would be uncomfortable for someone to endure during the day, it is relatively easy for a patient to hold this position while sleeping.

Charleston Bending Brace

The Charleston Bending Brace is the most common nighttime brace utilized, and it is created based on a cast or scan of the patient’s torso, making it a custom option. Using an x-ray of the patient’s spine, corrective forces are then added to the brace to help it reach proper alignment.

Providence Brace

The providence brace works similarly to the Charleston brace by overcorrecting the spine. However, instead of bending the spine in the opposite direction, which is what the Charleston brace does, the Providence brace instead elevates one shoulder slightly and applies lateral and rotational forces to the curve(s).

When Would You Use a Nighttime Vs. Full-Time Brace?

There are various reasons why one brace type may be preferred to another:

More Time Spent in the Brace

Some studies show that spending more time in a brace increases the odds of scoliosis curve progression being stopped. This would make full-time braces more appealing since those who use them wear them all day and night.

Greater Adherence

While those who have a full-time brace should wear them more often, that is only true if the individual wears their brace at all times, which is not always the case. Instead, the nighttime braces, since they only need to be worn at night, has a schedule that is easier to adhere to. For those who think they would struggle with wearing the full-time brace every day, the nighttime brace may be a more appealing choice.

Number of Curves and Degree of Curvature

The severity of scoliosis can also influence which type of brace would be preferred. For instance, curves that are at least 35 degrees, or those with double curves, are often better suited for a full-time brace. In comparison, singles curves that are less than 35 degrees can use a nighttime brace.

The Importance of Early Intervention

No matter which bracing type is used for your child, the most important thing to remember is that early intervention is the most crucial part of treatment. Children go through an adolescent growth spurt, which can cause existing scoliosis to rapidly worsen because of how quickly they are growing. By intervening before this growth spurt occurs, corrections can be made to the growth of the spine before more severe interventions (such as surgery) are needed.

Furthermore, while the initial elements of scoliosis treatment involve observation, annual pediatric check ups serve as a good method of early detection. Being proactive and staying on top of this ensures that your child can begin bracing as soon as they need it, further ensuring that the curvature does not progress too far.

Choosing the Best Scoliosis Brace

None of the scoliosis braces listed above can be considered the absolute best because some work better for specific scenarios. Still, one type of brace will be best for your situation, and the orthotists at Lawall Prosthetics & Orthotics can help match you with the best option.

Taking into consideration your situation and answering any questions you have, the Lawall team is here to help make your scoliosis brace decision easy.