Currently, bracing is the only non-operative treatment for adolescent idiopathic scoliosis advocated by the spine medical community.
All other forms of non-surgical treatment for adolescent idiopathic scoliosis - including chiropractic adjustment or osteopathic manipulation, exercise or other manual treatments, nutrition, acupuncture, etc. - have not been proven to be effective in preventing progression or reducing the curvature.
Patients with a curve that is between 20 to 30 degrees will usually be observed at 4 to 6 month intervals with an X-ray test to measure the curve. Any progression that is less than 5 degrees is not considered significant. If the curve progresses more than 5 degrees, then the curve will need treatment.
In general, treatment with a back brace will be recommended for patients with:
- A curve that measures 25 to 40 degrees, and;
- A lot of growth remaining (patients who are skeletally immature).
The primary goal of orthotic treatment (a back brace) for idiopathic scoliosis is to stop the progression of the spinal curve. Bracing does not typically reduce the degree of the curve/amount of angulation already present.
Since bracing only works to stop the progression of the curvature in a growing child, it is not used for those children who are already skeletally mature or almost mature. It is only used for younger children (e.g. girls who are about 11 to 13 years old, and boys who are about 12 to 14 years).
Brace treatment is usually used in girls up to one year after menarche, the onset of the female menstrual cycle. If an older child has a curve greater than 30 degrees and is almost mature, his or her curvature will be treated with observation only, as there is little growth left and bracing will be unlikely to be as effective.
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The only curves that tend to continue to progress after skeletal maturity are those that are greater than 50 degrees in angulation, so the treatment objective with a back brace is to try to get the child into adulthood with less than a 50 degree curvature.
While it is non-invasive and does not pose any risks to the patient, bracing for scoliosis is nonetheless a very difficult treatment option for many patients. Adolescence is usually difficult enough without having to appear different than one's peers by wearing a brace. That being said, compliance with wearing a brace is very important, as curves that progress can require fusion surgery and lead to potential long-term health problems.
Conclusion to Bracing Treatment for Scoliosis
Currently, the spine medical community advocates bracing as the only non-surgical treatment for idiopathic scoliosis. The objective of bracing treatment is to prevent the curve from progressing as the child grows, and studies have shown bracing is effective in stopping the progression of the majority of adolescent scoliotic curves.
There are a number of bracing options, and the physician will recommend a particular back brace and bracing schedule based on factors such as the location of the child's curve and degree of curvature. Compliance with wearing the back brace as prescribed is clearly vital to the success of bracing treatment.
Unfortunately, even with appropriate bracing, some spinal curves will continue to progress. Early on it is very difficult to tell which curves will be aggressive and continue to progress, and which curves will not continue to progress.
If the curve continues to progress to 40 - 45 degrees or more, then a spinal fusion surgery will usually be recommended. However, even if surgery eventually becomes necessary, the back brace can still be beneficial by helping delay the progression of the curvature and allowing the child to grow more before having a spinal fusion (which stops the growth of the spine).