There are several rigid back braces available on the market today to treat scoliosis. These braces can vary in how pressure is applied to the spine and ribs to prevent a scoliosis curve from progressing.
Some rigid braces require full-time wear, which is typically between 16 and 23 hours a day, whereas others are only worn about 8 to 10 hours per night while sleeping.
Some of the more common full-time braces include:
A Boston brace is typically made from one of several prefabricated mold options. After the orthotist (person making the brace) selects the mold that best fits the patient’s size and curve type, corrective pads and trim lines (cutouts) are strategically added to the brace by following a blueprint specific to the patient’s scoliosis curve.
The Boston brace works by applying corrective pressure on the convex (outer) side of the curve and cutting out corresponding areas of relief on the concave (inner) side of the curve so the spine can migrate in that direction.
The brace opens in the back, so the patient may need help getting into and out of it.
Another common TLSO is the Wilmington brace. However, unlike the Boston brace, the Wilmington brace is custom-fitted based on a cast taken of the patient while lying down, facing up. After the cast is made, corrective forces specific to the patient’s spinal curve are added before the brace is completed.
This brace goes onto the body similar to a tight jacket and is known as a full contact TLSO due to its lack of gaps or open spots.
The Milwaukee brace, which is the original cervico-thoracic-lumbar-sacral orthosis (CTLSO) invented in the 1940s, is an older and bulkier brace. Due to the effectiveness and relative convenience of today’s more modern braces, the Milwaukee brace is rarely used anymore. However, it is still sometimes used for curves higher in the thoracic or cervical spine.
In theory, both the Wilmington brace and Boston brace are effective full-time bracing options for scoliosis curves at T8 (mid-back or bottom of the shoulder blade) or lower. Sometimes a clinic has experience with the Boston brace or Wilmington brace, but not both, and that could determine which full-time brace is prescribed.
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The two most common nighttime braces in the U.S. include:
Charleston Bending Brace
The most commonly-prescribed nighttime brace is the Charleston bending brace. It is custom-fitted based on a cast taken of the patient’s torso. After the cast is created, corrective forces are added to the brace based on readings from the spine’s x-ray.
The Charleston bending brace is intended to be worn by laying down, not while up and moving. As such, the brace is able to apply stronger forces and is not restricted by considerations for the head to remain balanced over the pelvis.
In addition to applying lateral forces to push the curve closer to the back’s midline, the Charleston bending brace also applies pressure to bend and holds the spine in an overcorrected position. While it would be unrealistic for someone to be bent so far to the side while trying to go about the day, this extreme position can be held relatively easily at night while laying down and sleeping.
Similar to the Charleston brace, the Providence brace applies a hypercorrective force on the spine that is only feasible while laying down and sleeping at night. However, instead of bending the spine’s curve in the opposite direction like the Charleston brace, the Providence brace slightly elevates one shoulder and directly applies lateral and rotational forces on the curve (or both curves if it is a double curve).
The Providence brace is capable of pushing the curve toward the midline or beyond in some cases.
Sometimes physicians have more experience with either the Charleston bending brace or Providence brace, and have a personal preference for prescribing one or the other.
Choosing Full-Time vs. Nighttime Bracing
While full-time bracing and nighttime bracing have both been proven to be effective treatment options for scoliosis, the science is not settled regarding which is better.
Some studies show that the more time a person spends in a brace, the more likely the scoliosis curve’s progression will be stopped. However, other studies indicate that nighttime bracing could be better because patients are more likely to adhere to its simpler protocol.
In general, today’s doctors tend to favor full-time bracing for curves that are at least 35 degrees or for double curves. For single curves that are less than 35 degrees, nighttime bracing could be an option, especially if the patient expresses a preference for it.