Updated March 07, 2014.
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Scoliosis is a condition that can occur in all age groups from infants to the elderly, but the most common age of patients identified with scoliosis are adolescents. Within this adolescent age group, most patients with a spine curve are classified as having idiopathic scoliosis--meaning there is not a known cause for the condition. This compares to patients who have other conditions such as tumors, trauma, or other reasons to develop a spine curve.
Treatment of adolescent idiopathic scoliosis has been controversial for many decades, with some doctors preferring a watchful waiting, while others are more aggressive in recommending invasive treatments. The most difficult treatment decisions are for patients with mid-range curves between 20-40 degrees. The usual treatment for scoliosis has been:
In an effort to clarify the best treatment for adolescents in the mid-range of curves, doctors performed a study to compare observation with bracing. And the findings were very clear: scoliosis braces prevent progression of spine curves.
The study to determine the effectiveness of braces was a high quality scientific study. Some of the strengths of this study include:
At the time of the study conclusion, only 242 patients had completed the full study--this was about 5 years from the time the study began. However, the results were clear that there was a benefit of bracing to prevent scoliosis curve progression. Therefore, at that time, the researchers stopped the study to ensure all of the patients were receiving what was clearly the better treatment.
The bottom line is the group of adolescents who wore a brace did not have curve progression to the surgical threshold in 75% of patients, compared to 42% in the group of patients that was observed.Â
The study also clearly demonstrated that the braces have a dose effect--this means that patients who did not wear the brace for the prescribed amount of time, had a higher chance of curve progression. For this study, patients were instructed to wear the brace for 18 hours each day. The braces had temperature sensors so that researchers could confirm the actual amount of time the braces were worn. In patients who wore the brace less than 6 hours a day, there was the same rate of curve progression as the observation group. In patients who wore the brace more than 13 hours a day, there was a 90% success rate.
If you have a child with a diagnosis of idiopathic scoliosis, your should ask your provider the degree of curve of the spine (also called the Cobb angle). There is no change in the recommendation that children with adolescent idiopathic scoliosis, with a curve of less than 20 degrees, should continue to be observed for signs of progression of the curve. This means that bracing is not recommended for curves less than 20 degrees.
However, there is very clear evidence, that for children with curves of more than 20 degrees, that a brace should be worn, for at least 13 hours a day. This has been an area debated for decades by orthopedists, and therefore, not every doctor may be aware of this study. If you have concerns that your child should be wearing a brace for scoliosis, ask for an evaluation by a doctor that specializes in the treatment of adolescent spine deformities.
Sources:
Weinstein SL, et al. "Effects of Bracing in Adolescents with Idiopathic Scoliosis" N Engl J Med 2013; 369:1512-1521. October 17, 2013
Written or reviewed by a board-certified physician. See About.com's Medical Review Board.
Scoliosis is a condition that can occur in all age groups from infants to the elderly, but the most common age of patients identified with scoliosis are adolescents. Within this adolescent age group, most patients with a spine curve are classified as having idiopathic scoliosis--meaning there is not a known cause for the condition. This compares to patients who have other conditions such as tumors, trauma, or other reasons to develop a spine curve.
Treatment of adolescent idiopathic scoliosis has been controversial for many decades, with some doctors preferring a watchful waiting, while others are more aggressive in recommending invasive treatments. The most difficult treatment decisions are for patients with mid-range curves between 20-40 degrees. The usual treatment for scoliosis has been:
- 0-20 Degree Curve: Observation
- 21-40 Degree Curve: Consider Bracing vs. Observation
- More Than 40 Degree Curve: Consider Surgery
In an effort to clarify the best treatment for adolescents in the mid-range of curves, doctors performed a study to compare observation with bracing. And the findings were very clear: scoliosis braces prevent progression of spine curves.
The Study
The study to determine the effectiveness of braces was a high quality scientific study. Some of the strengths of this study include:
- Over 1,000 patients were initially evaluated at 25 different hospitals throughout North America
- The study was prospective, and randomized
- The study was stopped early because of the significance of the results
At the time of the study conclusion, only 242 patients had completed the full study--this was about 5 years from the time the study began. However, the results were clear that there was a benefit of bracing to prevent scoliosis curve progression. Therefore, at that time, the researchers stopped the study to ensure all of the patients were receiving what was clearly the better treatment.
The Results
The bottom line is the group of adolescents who wore a brace did not have curve progression to the surgical threshold in 75% of patients, compared to 42% in the group of patients that was observed.Â
The study also clearly demonstrated that the braces have a dose effect--this means that patients who did not wear the brace for the prescribed amount of time, had a higher chance of curve progression. For this study, patients were instructed to wear the brace for 18 hours each day. The braces had temperature sensors so that researchers could confirm the actual amount of time the braces were worn. In patients who wore the brace less than 6 hours a day, there was the same rate of curve progression as the observation group. In patients who wore the brace more than 13 hours a day, there was a 90% success rate.
What Should Your Child Do?
If you have a child with a diagnosis of idiopathic scoliosis, your should ask your provider the degree of curve of the spine (also called the Cobb angle). There is no change in the recommendation that children with adolescent idiopathic scoliosis, with a curve of less than 20 degrees, should continue to be observed for signs of progression of the curve. This means that bracing is not recommended for curves less than 20 degrees.
However, there is very clear evidence, that for children with curves of more than 20 degrees, that a brace should be worn, for at least 13 hours a day. This has been an area debated for decades by orthopedists, and therefore, not every doctor may be aware of this study. If you have concerns that your child should be wearing a brace for scoliosis, ask for an evaluation by a doctor that specializes in the treatment of adolescent spine deformities.
Sources:
Weinstein SL, et al. "Effects of Bracing in Adolescents with Idiopathic Scoliosis" N Engl J Med 2013; 369:1512-1521. October 17, 2013