Scoliosis Bracing: Nonsurgical Treatment for Scoliosis

What is scoliosis bracing?

When a growing child has scoliosis, their doctor may recommend a brace when the spine's curvature has reached a certain threshold. A scoliosis brace is a plastic molded orthosis (brace) that goes around your torso and pushes on your spine. It is custom made to your body and based on your underlying scoliosis curve. The goal of bracing is to help prevent the progression of the curve. The brace is not expected to correct the existing curve.

Once a curve reaches 50 degrees, surgery is typically recommended, because curves over 50 degrees will continue to progress even once a patient is finished growing. Thus, the goal of bracing is to help prevent a curve from reaching 50 degrees.

How does a scoliosis brace work?

The brace works by pushing on your curve while you are growing, to help influence the growth of your spine and prevent worsening of the curvature. Scoliosis braces only work in children and adolescents who are still growing.

What are the different kinds of braces for scoliosis?

There are several different types of braces for scoliosis, and they all work in similar ways. Braces are custom made to a patient’s body shape, as well as their curvature. When worn, the brace pushes against the patient’s spine.

The thoracic lumbar sacral orthosis (also known as a thoracic lumbosacral orthosis, or TLSO) and Boston brace were the types of braces initially studied in the Bracing in Adolescent Idiopathic Scoliosis Trial (BrAIST). In this landmark study, a multicenter randomized investigation demonstrated that bracing is superior observation in helping to prevent curve progression and the need for surgery in patients with idiopathic scoliosis.

The TLSO and Boston braces are rigid plastic braces with Velcro straps in the front or back. Newer versions include the Rigo-Cheneau and 3D Boston Brace, which also work on the rotation of the spine and torso that occurs in scoliosis. Providence bracing, also known as a “nighttime brace,” is an over-correction brace. A Providence brace cannot be worn during the day, due to the over-correction that a patient has while wearing it. It sometimes is indicated in patients with lumbar curves or smaller thoracic curves. Since it is only worn at night, patients are sometimes later transitioned to a TLSO brace if their curve progresses and 18+ hours of bracing is recommended.

How long does it take to fix scoliosis with a back brace?

A brace is generally recommended to be worn for a minimum of 18 hours per day, with breaks for sports and showering/bathing. (Unless you were prescribed a nighttime brace.) This number is based on studies which have shown maximum efficacy of bracing when worn a minimum of 18 hours per day. Typically, patients are recommended to wear a brace while they are growing. Most physicians/surgeons will monitor your remaining growth with a hand X-ray. Once you are done growing, you get to stop wearing your brace.

What degree of scoliosis requires a brace?

As long as a patient is still growing, curves over 25 degrees are typically recommended for bracing. In younger patients, your doctor may recommend bracing for a curvature of as little as 20 degrees.

Can I do physical therapy instead of wearing a scoliosis brace?

For scoliosis curves within brace-range, physical therapy has not been proven to prevent progression of curves instead of wearing a brace. However, physical therapy has been shown to be helpful in conjunction with bracing. Physical therapy can also help make a brace more comfortable for the patient.

What are the side effects of scoliosis braces?

Scoliosis braces can be uncomfortable and take some time to get used to. Since there can be some emotional component to starting bracing, patients are recommended to reach out to support groups like CurvyGirls, which provide mentorship and support to both patients and their parents.

Sometimes the brace can rub against you and cause some skin irritation. If there is significant skin irritation, we recommend having your brace assessed by the brace shop. Braces push on your rib cage and can cause some changes in the shape of your rib cage. Scoliosis bracing does not stunt growth.

Are scoliosis braces covered by insurance?

Typically, scoliosis braces are covered by insurance. It is important to talk to the brace shop about the insurance process to determine if there will be any out-of-pocket expense.

How will I be fitted for my scoliosis brace?

Scoliosis braces are measured in the brace/orthosis shop. Each brace shop makes braces slightly differently, but measurements of your torso are made, and sometimes a three-dimensional scan of your torso is also obtained. A brace takes about four weeks to make, since it is customized to you and to your curve.

How can I tell if I’m wearing my scoliosis brace enough?

Some brace-making shops have compliance monitors built into the brace that your doctor can use to see how many hours per day you are wearing your brace. However, we also recommend keeping a log of how many hours you are wearing your brace in the beginning to make sure you are wearing it for the amount of time your doctor recommended.

What if I grow out of my scoliosis brace?

If you grow out of your scoliosis brace, or if you have any issues with your brace (sore spots, areas of rubbing), we recommend you see the brace shop for an adjustment. Even if you are not seeing your doctor for a couple months, the brace shop is independent from your doctor and can see you for any issues you are having.

If I am an adult, is it too late to wear a brace for scoliosis?

A scoliosis brace is mainly indicated in patients who are still growing, as the principles of scoliosis bracing works by pushing on the growing spine.

Posted: 3/13/2024

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Reference

• Dolan LA, Weinstein SL, Dobbs MB, Flynn JMJ, Green DW, Halsey MF, Hresko MT, Krengel WF 3rd, Mehlman CT, Milbrandt TA, Newton PO, Price N, Sanders JO, Schmitz ML, Schwend RM, Shah SA, Song K, Talwalkar V. BrAIST-Calc: Prediction of Individualized Benefit From Bracing for Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976). 2024 Feb 1;49(3):147-156. doi: 10.1097/BRS.0000000000004879. Epub 2023 Nov 23. PMID: 37994691; PMCID: PMC10841822.

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