Update on Bracing for Scoliosis

Idiopathic Scoliosis (IS) is a three-dimensional deformity of the spine. It is characterised by a lateral curve with a Cobb angle fo 10 degrees or more. Bracing is one type of conservative therapy used for scoliosis. There are many different brace designs. They all have the same objective: to restore the normal contours and alignment of the spine. I had the great pleasure of hearing Dr. Angelo Aulisa talk at SOSORT’s Pre-Conference in San Francisco yesterday. He spoke about the current evidence for bracing for scoliosis. 

What is the Evidence for Bracing

Last year’s trial study (BrAIST) has provided us with high levels of evidence in favour of bracing. This trial demonstrated a 72% treatment success after bracing. Moreover, last year’s research showed positive results for bracing of patients with curves greater than 40 degrees who refused surgery. Results were particularly good if they had low levels of rotation and a Risser Score* between 0-2. Bracing has been shown to prevent curve progression, but further research is required to increase confidence in the medical community. 

Brace or No Brace for Your Child?

Your physiotherapist who is trained in the treatment of scoliosis will work with your doctor to determine the course of treatment. SOSORT** guidelines should be followed when it comes to providing conservative treatment options for your child. These guidelines provide us with criteria for selecting who is suitable for Physiotherapeutic Scoliosis Specific Exercises (PSSE). This includes methods such as Schroth and SEAS (Scientific Exercise Approach to Scoliosis). They also provide guidelines on who would be a suitable candidate for bracing and therapy combined. 

Does Bracing Prevent Surgery?

In many cases, yes. However this is not a guarantee. There are many factors affecting the progression to a ‘surgical’ level curve. Also remember that you have choices. Surgery is not a ‘must do’ for everyone. Surgery is usually considered for scoliosis at about a 45-50 degree curve, with some exceptions. However in the case of idiopathic scoliosis this is not a life or death decision. You should take the time you need to make informed decisions about the best options for your child. Your physiotherapist can work with your surgeon and orthotist to ensure the best team approach and provide you with your options. 

Right now, we can conclude that bracing is an effective alternative treatment for AIS in many cases. 

 

*Risser Score provides us with some guide as to how much skeletal growth is left. Risser 0 is an immature skeleton and Risser 5 is indicates that growth is complete or near complete.

 

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