Bracing Treatment in Adolescent Idiopathic Scoliosis (AIS)
As mentioned, a spinal brace with regards to treatment for scoliosis is designed to PREVENT a curve from progressing. It DOES NOT IMPROVE the curve. The brace is a TLSO, which stands for thoracolumbosacral orthosis (orthosis is another word for brace).
Every provider at COA is slightly different with his/her scoliosis treatment, including when to prescribe a brace and which type of brace to prescribe. However, in general, braces are recommended for curves between 20-40 degrees in a child who has a "significant" amount of growth remaining. There are times when a provider may brace a curve that is slightly smaller. It is not too often that a brace will be prescribed for a curve greater than 40 degrees as those curves are too big for a brace to be effective.
If you're interested in learning more about bracing for AIS, contact COA today.
The Boston Brace is a brace that was developed in Boston in the 1970's and to some is still considered the "gold standard" of bracing. It is made of multiple different pre-fabricated pieces that are placed together to give your child the custom corrective forces that are needed.
The Boston Brace is most effective when worn for as many hours as possible during the day. Ideally, your child should wear the brace 23 hours per day - only removing it for bathing and sporting events. Studies have demonstrated that wearing this brace for less than 12 hours per day is likely not effective at all.
The brace itself is relatively rigid. It begins just under the level of the axilla (underarm), and ends at the level of the tops of the femur bones. A seamless shirt is typically worn under the brace.
The Providence brace was first introduced in the early 1990's at the Children's Hospital in Rhode Island. It is a brace that is intended just to be worn at night. Similar to the Boston brace, the brace is a rigid plastic brace that is fitted from the axilla (underarm) to the tops of the femur bone.
The Providence brace is a bending brace that not only provides correction in the front view, but is intended to unrotate the spine. Recall that rotation is the chief deformity in scoliosis. Because the brace tends to be hypercorrective, it can only be worn in the evening time. Typical recommendations are to wear the brace between 9-12 hours in the evenings. Please discuss wear times in further detail with your orthotist and you COA doctor.
Unfortunately, braces are not 100% effective at preventing curve progression. There are multiple factors that are involved in brace efficacy - some are modifiable, and some are not. Three things absolutely necessary for a brace to be effective
- Your child has to wear the brace for the prescribed amount of time
- The brace has to provide the proper amount of correction
- The brace needs to be worn correctly and adjusted regularly
At COA, we strive to work closely with you and your child to ensure all of the factors listed above occur. We reccommend regular check-ups, typically every 4-6 months, during scoliosis treatment, to ensure that the brace is working correctly. Once a brace is made, your child will have an "in-brace x-ray" at our office to ensure that the brace is providing an adequate amount of corrective force. It is also improtant that you and your child have frequent follow-up with the orthotist (brace maker) to ensure that the brace is fitting appropriately.
How long does my child have to wear a brace?Your child will wear the brace until he/she is done growing. On average this is approximately the age of 14 in girls and 16 in boys.
How much does the brace cost?Braces are custom made, but are not made at Children's Orthopaedics of Atlanta. Braces are typically covered somewhat by insurance, but there is usually some type of out-of-pocket expense depending on the deductible. Since the braces are custom made, they are not inexpensive. However, often times with orthotics companies the charge for the brace not only includes the brace itself, but all of the follow-up fittings that are required. If the cost is more than you can afford, ask for a payment plan. Most medical practices will offer a finance-free payment plan, typically up to two years.
Will people see the brace under my clothes?It depends on the type of clothing that is worn. For clothes more baggy, the brace will likely not be noticeable at all. But, for more tightly fitting clothes, the brace may be visible.
Is the brace comfortable?The brace itself is rigid and takes time to get used to. The brace maker (orthotist) will assist your child in weaning into the brace. While braces may not be as comfortable as a t-shirt per se, they should not be painful. If the brace is painful, we at COA would recommend that you and your child contact your orthotist to see if the brace can be modified to make it more comfortable.
Can I still do sports with my brace?Typically, your child can perform sports regardless of the severity of the scoliosis. If your child is in an "all-day" brace such as the Boston Brace, we would typically reccommend that your child perform sports without the brace on. However, please consult with your COA doctor first prior to these sporting activities to ensure that they are safe.