A scoliosis brace is a medical device used in children and adolescents with scoliosis. It helps slow or completely stop the sideways curve in your spine from getting worse.
Scoliosis is a condition that causes an abnormal curve in your spine.
A scoliosis brace is a device worn around the torso that can help prevent the curve from getting worse. It can also make it less likely that you’ll need surgery in the future after bone growth has stopped.
A brace is the only available treatment that can potentially slow progression of the curve in a child or adolescent whose bones are still growing. It doesn’t work after bone growth has stopped.
A scoliosis brace is designed to slow or stop progression of the spinal curvature caused by scoliosis.
Rigid braces put pressure on your spine in several places to help prevent it from curving more than it already has. Dynamic braces slow curve progression by retraining your body into maintaining a corrective posture.
Both types of braces may slow progression enough to remove the need for surgery, but they can’t completely or permanently straighten your spine.
A brace that goes from your thoracic spine (upper back) to your sacral spine (buttocks) is called a thoracic-lumbar-sacral orthosis (TLSO). It covers your body from your armpits to your hips. It’s the most common style of brace.
A brace that goes from your cervical spine (neck) to your sacral spine is called a cervical-thoracic-lumbar-sacral orthosis (CTLSO). It braces your spine from your neck to your hips.
Some braces are worn full-time; others are worn only while you’re sleeping (nighttime).
- Milwaukee brace. This was the original scoliosis brace. It’s a CTLSO. It has a metal superstructure that’s very rigid and quite noticeable because it’s worn outside of your clothing. Because of its size, bulk, and appearance, it’s not used much anymore.
- Boston brace. This is the most commonly prescribed brace today. It’s a TLSO. It fits like a jacket, covering your body from your armpits to your hips. It’s made of hard but lightweight plastic. It doesn’t have a superstructure, so it’s not very noticeable under clothing. A prefabricated brace in your size is customized to exactly fit your body and spinal curve. It closes in the back, so it you may need help putting it on and taking it off.
- Wilmington brace. This type is similar to the Boston brace. It’s made of the same material and fits like a jacket, but it closes in the front. It’s custom-made for you using a plaster mold of your torso.
- Charleston bending brace. This is the most prescribed nighttime brace. It’s a TLSO that’s custom-made to fit your body and spinal curve. It puts strong pressure on your spine, bending it past the midline of your back. This overcorrection is only possible while you’re lying down.
Braces have been used to treat scoliosis for over 450 years, but there are still questions about their effectiveness.
Braces can only slow or stop the progression of a spinal curve. They can’t get rid of the curve or straighten out the spine.
According to the American Association of Neurological Surgeons (AANS), they’re effective in around 80 percent of people treated with them.
improving the effectiveness of bracing
A brace won’t work if it isn’t worn correctly or for the recommended amount of time. For maximum effectiveness:
- wear your brace correctly
- check often to be sure it fits properly and have it revised if it doesn’t
- wear it for the recommended amount of time, which is often 16-23 hours a day
Understand that dynamic braces may not be as effective as rigid ones.
Scoliosis is a condition that causes your spine to curve too much to the left or right side of your body.
Abnormal curvature of the spine can lead to:
- uneven shoulders, waist, and hips while standing
- your head not being centered over your body
- your rib cage tilting up on one side
- your body tilting to the left or right
- back pain
According to the AANS, an identifiable cause is found in only 20 percent of people with scoliosis. The remaining cases are idiopathic, meaning the cause is unknown.
The most common identifiable causes are:
- malformation of the spine that occurs before birth (congenital anomaly or birth defect)
- neuromuscular conditions such as cerebral palsy and muscular dystrophy
- spinal cord injury
Tools used to diagnose scoliosis include:
- physical examination
- Adam’s Forward Bend Test, which is a screening test to look for asymmetry in the torso while you’re bending over
- X-rays, CT or MRI images of the spine
Severity of the condition is determined by measuring how many degrees out of alignment the spine is.
How your scoliosis is managed depends on:
- How mature your bones are. A brace is more likely to be recommended if your bones are still growing.
- Where the spine is curved. Curves in your upper back tend to get worse more often than in other area.
- How severe the curve is. In general, bracing is only used on curves that are between 25 and 40 degrees. Curves over 40 degrees are usually treated with surgery.
For significant scoliosis, bracing is the only treatment option until your bones have stopped growing. If you have mild scoliosis or your bones have matured, there are other treatment options.
If your curve is mild, your doctor might decide to watch and see what happens over time rather than treat it. If the curve starts to get worse, treatment might be recommended.
How your doctor follows your scoliosis depends on your age.
Usually children see their doctor every 4 to 6 months until they’re out of their teens. Unless things are getting worse, adults with scoliosis are usually followed with an X-ray every 5 years.
Braces can only slow progression of scoliosis. Surgery can potentially fix the curve in addition to stopping it from getting worse.
Surgery recommendations are based on:
- your age
- previous treatment
- the severity of your curve
Surgery is recommended when:
- the curve is 40 degrees or larger and is progressing in a child
- an obsolete surgical procedure performed on a child needs to be revised when they become an adult
- the curve is 50 degrees or larger and there are signs of nerve damage, indicating spinal stenosis
Adults who have spinal stenosis undergo a procedure called decompressive laminectomy. It creates more room for nerve roots to move through narrowed (stenosed) vertebrae.
Whether or not you need to wear a brace after surgery depends on the surgical technique used.
Bracing can be effective for slowing or halting progression of your spinal curve when you have scoliosis.
It can’t completely or permanently straighten your spine. It can only be used if the curve is moderate in size and while your bones are still growing.
For maximum effectiveness, your brace must be worn for the number of hours per day your doctor recommends. Braces are worn until your bones stop growing.
In an adolescent, this is usually 3 or 4 years. When scoliosis is diagnosed in childhood, a brace may need to be worn for an extended period of time, usually years.
A scoliosis brace can help slow or stop curvature progression of your spine. It’s only effective when the curvature is moderate and while your bones are still growing.
Following your doctor’s recommendations regarding when and how long to wear a brace is critical for it to be effective.