From the back view, a person’s spine is usually straight, rather than curved. However, sometimes the spine not straight and the actual vertebrae are improperly aligned. This is referred to as scoliosis. Mild scoliosis, where the curve is minimal, usually does not require medical intervention and approximately 10% of youth have some form of this curvature. A small fraction of this population, approximately 1%, will require medical attention. Scoliosis can cause instability, fatigue, pain, and more severe cases can even interfere with breathing and can cause arthritis of the spine.
Treatment for scoliosis usually includes at least one of the four possible options:
· Observation
· Bracing
· Surgery
· Alternative Treatment (exercise, nutrition, chiropractic care)
The three most common back braces used to treat scoliosis are:
The Boston Brace, usually referred to as a TLSO (thoraco-lumbo-sacral-orthosis), is custom fitted using a mold of the user’s body. This brace, also referred to us the ‘underarm brace’ applies three points of pressure to work against the curve of the spine. The brace can be worn under clothing and is typically required 23 hours per day. The Boston Brace is usually prescribed for curvatures involving the lumbar or thoraco-lumbar section of the spinal column.
The Milwaukee Brace, also known as a CTLSO (cervical thoracolumbar sacral orthosis), is a full torso brace that extends from the pelvis to the base of the skull. It was originally designed by Blount and Schmidt in 1946 for postoperative care when surgery required long periods of immobilization. As the design of the brace advanced, it also became used as a substitute for surgery. The less invasive option gave parents a welcomed alternative, although the brace wearing therapy is lengthy and some extreme spinal curves do require surgical correction.
Unlike the thoracolumbar sacral orthossis (TLSO), the Milwaukee Brace can control high thoracic and cervical spinal curvatures. The Milwaukee Brace is a custom fabricated brace, constructed based on a mold of the user’s body. The brace is normally constructed of three components: (1) a pelvic girdle, (2) a thorasic pad, and a (3) neck pad. These three components apply three points of pressure, which counter the curve of the spine. Generally, the thorasic pad applies counter pressure to the spinal curve, while the pelvic girdle and neck pad apply pressure in the opposite direction.
The brace is normally used with growing adolescents to hold a 25 and 40 degree advancing curve. The brace seldom corrects the curve, but may be able to minimize the progession to an acceptable level. Otherwise, surgery may be required. It is important that the child wear the brace as prescribed, which may mean 23 hours a day for several years. Special exercises to correct the curve are often prescribed and physical activity helps to maintain the torso muscles.
The Charleston Bending Brace is also referred to as the ‘nighttime brace’, as it is only worn during the night. The brace us custom fabricated from a mold of the user’s body. The mold is taken while the child is bent to one side and applies pressure against the curve. The child does not require bracing during the day and there are some studies that show this can be an effective treatment for curves that are in the 20 to 40 degree range with the apex of the curve below shoulder blade level.
Regarding of which brace is prescribed, children need the support and encouragement of parents and medical staff to adjust to wearing the brace. Routine follow up appointment with the orthotist are required in order to evaluate the child’s growth and the effect of the brace. If the brace is not adjusted correctly, the child will experience undue pressure and possible permanent tissue and/or skeletal injury. Under-use of the brace will cause the curve to progress.
Children and families are often fearful of the possible negative social repercussions of wearing a brace during social interactions, such as during school. However, it must be stressed to the child that the long-term positive impact of wearing the brace outweighs any social awkwardness.