The term scoliosis applies to a lateral spinal curvature of more than 10 degrees with an accompanying rotational element. Progressive scoliosis is present in approximately 3% of children under the age of 16 worldwide. Cases of more than 50 degrees generally require surgical correction. The group that lie between 10 and 50 degrees are commonly treated with the use of a thoracolumbosacral orthosis, better known as rigid bracing. The aim of this conservative treatment is to stimulate correction of the curvature of the spine by applying an external force.
A randomised control trial aimed to determine whether rigid bracing was an effective treatment strategy for 10-15 year olds with a spinal curvature of between 20 and 40 degrees over a 2 year period. 146 patients received a brace and 96 patients underwent observation only. The brace group were instructed to wear the brace for 18 hours daily and compliance was monitored electronically. Treatment success was classified as: Successful – skeletal maturity was reached without spinal curvature progression; or Unsuccessful – spinal curvature reached 50 degrees or more.
After a 2 year period, rigid brace patients achieved a treatment success rate of 72%, compared to 48% in the observation only group. A significant correlation between average hours of brace wear and a successful outcome.
What does it all mean?
When compared to the cost, pain and long rehabilitation period post surgery, the positive effects of rigid bracing, though hard to deal with at first, have been shown to be significantly better than taking a “wait and see” approach.
Bracing when coupled with a patient tailored exercise program to strengthen the musculature required to stabilise the spine, a custom orthosis has a high success rate in preventing scoliosis developing in adolescents.