Brace Treatment for Idiopathic Scoliosis - Does it Work?

“I wore a brace for 3 years and my curve is still 27 degrees!! I totally wasted my time!”

If you were treated with a brace for your scoliosis, did you feel disappointed that your curve wasn’t “gone” after the ‘hassle, sweat and tears’ you went through? And did you think that your doctor was a bit off his/her rocker expressing satisfaction at the outcome of your treatment?

Well, you did NOT totally waste your time. The fact that your curve did not progress to the point of needing surgery is a huge success. When you have the brace on, the pads inside of it are pushing in on either side of your body at the levels of your spine that are most curved, which does cause the curve to straighten. If you had x-rays done while in your brace, you could see that your scoliosis curve was smaller and your doctor and orthotist (brace specialist) can see on the x-ray where the pads are pushing and if any adjustment is needed. This external pressure is most important when you are up on your feet during the day to hold that curve where it is. (Your curve is worse when you are standing due to the force of gravity on your spine. When you lie down, your curve is smaller because your spine is relaxed.) Nothing can permanently straighten the curve in your spine except surgery. The goal of brace treatment is to keep the curve(s) from getting larger while you are still growing. When your doctor thinks that you are reaching the end of your growth, you will start to gradually wean out of the brace and still be monitored to make sure your curve isn’t progressing. If you had a curve, for example, of 28 degrees before wearing a brace, and if after you were completely weaned from your brace you still had a curve of approximately 25-30 degrees, that is successful brace treatment.

There have been multiple studies done on different types of braces - hard plastic braces, flexible braces made of multiple straps, bending and nighttime-only braces to name a few. Some doctors favor one type over another and feel like their patients are more compliant and successful with that type. The basic concept that all braces share is the pressure they apply externally to the curved spine. Similarities that have come out of various studies done over the years were presented at the SRS Annual Meeting in September 2017 including:

• A study done comparing the effectiveness of two different treatment protocols showed similar results to prior studies that longer hours of brace wear improved outcomes in high risk adolescent idiopathic scoliosis patients.
• Brace wear for lumbar curves is more effective than for thoracic curves.
• Increased rotational deformity in the spine can decrease the success of brace wear.
• The distance from the greatest part of the curve (apex) to the center of the body, the location of the apex in the spine, and the tilt of the 4^th lumbar vertebra have shown a correlation to curve progression and possibly to low back pain.
• The larger the curve is when your spine is done growing, the more likely it will show slow progression into adulthood.