Scoliosis: Bracing in the Treatment of Idiopathic Scoliosis

The vast majority of patients that are identified as having scoliotic curves require no treatment other than regular check-ups so that their curves can be measured and monitored. Generally, patients are followed every six months until growth is complete. The overall goal of treatment is to prevent the curve from worsening over time. In general, bracing is initiated when the curve measures 20-25 degrees in a skeletally immature patient. Research has shown that once a curve reaches 20-25 degrees, there is a good chance that the curve will progress until growth is complete. Therefore, bracing treatment is continued until the end of growth. Once a curve is greater than 40 degrees, however, surgical intervention is usually required. The ideal brace for adolescent idiopathic scoliosis is the Boston TLSO (thoracic-Lumbo-Sacral Orthosis) worn full time (18-23 hours/day).

Boston Brace

The ideal brace for adolescent idiopathic scoliosis is the Boston TLSO (thoracic-lumbar-sacral orthosis) worn full-time (18-23 hours/day). Studies have shown that bracing can successfully prevent curve progression in the overwhelming majority of patients. The Boston TLSO fits under the arms and around the rib cage, lower back, and hips.

How is the brace fitted?

The brace is fitted by an orthotist who will take several measurement to custom-fit the Boston Brace TLSO. After getting the measurements, the orthotist will fabricate a brace designed to correct the specific curve. After the brace is made, it may be necessary to have several modifications made to ensure both overall comfort and adequate correction.

What happens after I get the brace?

After you pick-up your brace, it may take several weeks to wean yourself into wearing it full-time (18-23 hours/day). Most patients start wearing it at nighttime and then gradually extend the time into the day. After you have been wearing the brace full time for several weeks (4-5 weeks), you will return to the orthopaedic clinic for an x-ray in the brace and a follow-up examination. The x-ray is taken to ensure that the brace is correcting the curve effectively.

Response of curves to bracing

It is important to realize that the goal of orthotic treatment of idiopathic scoliosis is simply to halt curve progression. Most curves will appear substantially improved while the brace is worn; however, the great majority will return to the original pre-treatment magnitude shortly after brace discontinuance.

What do I do about skin care?

This is a common question that comes up with full-time bracing. It is important to maintain good skin care while in the brace. It is recommended that a cotton T-shirt be worn underneath the brace so that the brace does not have direct contact with the skin. It is also a good idea to remove the brace and check the skin for any signs of breakdown. If there is redness, rashes, or breaks in the skin, it is important to call the orthopaedic clinic.

How do I care for the brace?

The hard outer plastic shell can be wiped down with soap and water. Make sure that you towel dry or use a blow dryer on a cool setting it the inside does get wet. If there are problems with the straps, padding, or brace itself, please call the orthopaedic clinic. Usually, you will need to go to the brace shop to have your brace repaired/modified.

Do I have specific limitations when wearing the brace?

Unless otherwise instructed by your physician, you are not restricted from participation in any sport or activities. If you are participating in an organized sport, you can use this 1-2 hours as part of your "brace-free" time. You should have no limitations because of your scoliosis or brace.