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What is the best Brace for AIS -Adolescent Idiopathic Scoliosis, well the answer is simple , all things being equal and using the latest brace technology, it's the brace that a child will wear as prescribed.
In the treatment of scoliosis, the use of a brace will be essential when it comes to halting scoliosis curve progression. The main goal in using a brace for scoliosis, is to avoid more invasive spinal fusion surgery.
The age-old question about what is the best treatment plan specific to scoliosis is a very difficult one to answer because the best option, all other things being on equal footing, is always the one that has the strictest adherence to the treatment protocol.
Research shows that the stricter the adherence to the treatment protocol (whether that's 12,18, or 24 hours of wearing the brace with a couple of hour breaks during the day), the more effective the results in halting the curve progression during their critical growth years.
There are of course several considerations to take into account specific to the severity of the curve, the placement of the curve, the number of curves, etc., but taking all of those things into consideration, if you're preteen or child is not willing to wear the brace according to the treatment protocol, even if you have what you determine to be the best brace in the world, with the best technology, provided by the very best scoliosis specialist In the world, it will do absolutely no good.
Here you will find more information on everything related to Scoliosis.
Scoliosis and Scoliosis bracing has been around for thousands of years and can be traced back to the 5th century B.C. While doctors are still not sure what causes Scoliosis, the understanding of the human body and underlying musculoskeletal and physiological basis for treating scoliosis and making better braces has drastically improved.
Millions of people each year are diagnosed with Scoliosis. While the vast majority of those diagnosed with this condition will not have to actually undergo any type of treatment other than monitoring to ensure that there is no more curve progression, treatment can vary.
Treatment for (AIS) adolescent idiopathic scoliosis, can be as simple as physical therapy with monitoring for mild cases, to using a scoliosis back brace for moderate cases. In severe cases, where the scoliotic curve is greater than a 45 degree Cobb angle ( a unit of measurement for tracking spinal curve progression), either a minimally invasive surgery called internal bracing/fusionless procedure is needed, or in more severe cases, a full spinal fusion surgery is required.
Although scoliosis affects all ages, including those children still in the womb (congenital scoliosis), the condition is typically first diagnosed and treated during childhood/adolescence and will present itself during puberty . It is a womb-to-tomb abnormality of the spine that affects the preborn while in the womb, as well as the elderly that experience degenerative scoliosis, and all ages in between.
Most of these diagnoses, almost 70%, will not require any intervention at all, since they are considered mild cases of scoliosis. In mild cases, it's sufficient to use physical therapy and/or a “wait and see approach” of monitoring the curve progression over time, with six month follow ups to ensure the Cobb angle does not go beyond the 25 degree angle.
In those that are considered moderate scoliosis cases, (An abnormal curve which is greater than 25 percent from normal), treatment is required. The primary treatment method for treating moderate scoliosis is the use of a back brace according to the National Scoliosis Foundation.
Once the curve progression has gone beyond a 45 degree Cobb angle from normal, it's time to consider a fusionless procedure, also known as internal bracing, or adopt the more invasive full spinal fusion surgery.
Scoliosis affects about 2-3 percent of the population in the United States, or an estimated 6 to 9 million people. Of this estimate, nearly 3 million children are affected.
When deciding on treatment for scoliosis for your child, parents should seek out a scoliosis specialist that has the experience and expertise to recommend a treatment plan that is best suited for your child’s particular scoliosis condition, and has trained their entire career to understand how a child grows and heals, from a fundamental musculoskeletal perspective. A board certified pediatric orthopedist is one of the most specialized doctors specifically trained and most experienced to properly evaluate and treat musculoskeletal (bone, joint, or muscle) problems in a growing child.
You might be surprised by the amount of training a Pediatric Orthopedic Surgeon receives.
Not only are they medical doctors, but they have to learn the unique nature of medical and surgical care of children through advanced training, as well as real-world experience in practice that goes far beyond the training typical doctors receive.
As part of their formal education and training, a Pediatric orthopedic surgeon will have completed the following:
Soft braces, commonly referred to as dynamic braces, are a cloth/fabric based alternative brace to the plastic molded brace which has been the standard in the industry.
The soft braces are usually made with a combination of some type of vest or shirt that has multiple elastic straps and/or bands which will extend from the shoulders down to the hip/buttocks region. The soft brace uses traction from the tightening of elastic, and provides support and pressure where the curve is beyond 25 degrees from normal.
As the elastic is stretched and creates greater resistance, the brace pulls the spine in the desired direction, opposite to the curve .These straps can then be adjusted, either tightened, or loosened, to apply pressure to the outside of the curve where needed throughout the treatment plan. This particular design does allow for a wider range of movement in the torso, making for a better treatment plan.
The key advantages to soft braces for scoliosis are that they are not rigid like hard braces, making them a more comfortable option for children. This increased flexibility and comfort allows for more mobility, and greater compliance in actually following the scoliosis brace treatment plan prescribed by a scoliosis specialist. This increased comfort and mobility can often make the difference for children as to whether they decide to adhere to the recommended treatment plan prescribed by a doctor, or take their braces off more often, and for longer periods of time because the hard braces cause too much discomfort. At the end of the day, a child that does not wear his brace due to discomfort will certainly affect the treatment plan’s desired result of halting curve progression.
Because most of the children that are being treated for Scoliosis using a brace fall in the 10 to 15 year age group, they are also particularly influenced by what their peer group think about them. In considering using a soft brace or a hard brace, parents should take into consideration if there will be less compliance in using the hard brace because it is more noticeable or pronounced, and not easily hidden under clothing. Anecdotal evidence as well as scientific studies point to the fact that compliance increases amongst those teens & preteens that use a soft brace, over a hard brace due to discomfort and social stigma associated with hard braces.
When the subject of Scoliosis comes up, you will hear the term TLSO, a thoracic lumbar sacral orthosis. A TLSO brace is the most commonly prescribed back brace for scoliosis, and provides support from the upper back, or thoracic region, to the buttocks, or the sacrum.
A typical treatment plan prescribed by a scoliosis specialist will include wearing a brace from 18 to 22 hours per day depending on the severity and type of scoliosis, as well as the growth stage of the child. This usually means that a child diagnosed with Scoliosis will have to wear the brace most of their waking and sleeping hours in order to achieve the best results.
A treatment plan prescribed by a scoliosis specialist is only as good as it is followed to the letter. It is like medicine that is taken as it is prescribed. When you take the required dose for the number or times per day and for the total number of days needed, then you can expect a good outcome. However, if a child is prescribed wearing a brace for 18 hours a day, and they decide that they only want to wear it at night and then take it off at school and stuff it in the locker room because they are afraid that their school peers will make fun of them, then you can expect that the curvature of their spine from scoliosis will not halt, but will actually worsen. The goal with any brace is to stop the curve progression and wearing the brace for the number of hours recommended is key to achieving this objective. Studies have shown that patients wearing their braces for the prescribed hours per day reduce the likelihood of needing spinal fusion surgery.
Although there is some variance amongst specialists on the exact degrees per classification, scoliosis is classified as mild, moderate, and severe.
Full time braces are the gold standard for keeping curve progression from worsening. That being the case, night time braces are typically only prescribed for those children exhibiting less than a 25 to 35 degree scoliotic spine, or when wearing a full time brace is not possible due to non-compliance by the child and only when they have a single lumbar or thoracolumbar curve.
Studies have shown that nighttime bracing is effective in stopping further curve progression when used properly and for the recommended time period. This option is typically used when there is poor patient compliance, as often occurs in full-time bracing. Of course fewer hours in a brace may mean curve correction takes longer than full-time bracing. There are studies that show very positive results specifically for single-major lumbar/thoracolumbar curves not exceeding 35 degrees. The study noted that nighttime bracing specifically helped in limiting the occurrence of secondary curve formations.
Social stigma- It is no secret that children, especially preteens and teens, care greatly about what their peers think about them. From this perspective, wearing a brace at home, and not at school or during sports and other social events, is a very attractive option for children and their parents.
Children are more likely to comply – Following an 18 to 22 hour prescribed treatment plan can be very difficult for the strong willed child, and parents who understand that despite their best efforts, their child is not going to comply when they get out of the eyesight of their parents. Most scoliosis specialists will agree that compliance is often the most difficult part of a treatment plan that involves wearing a brace for most of the day and night. Given the option, parents may opt for a night time brace realizing that although curve correction may come slower, it is better than having a full-time brace which is not being worn for the required daily hours.
Maintenance – This brace is beneficial in preventing scoliosis from returning in patients, and maintaining their curve from progressing after they have finished their treatment plan. Unlike an exercise-based approach, wearing a night time brace can help maintain curve correction in a child until they reach full skeletal maturity.
Great option for early intervention – When a child is too young or weak to follow an exercise-based treatment, or is unable to perform the exercises properly, a night time brace is a great option.
Curve Correction takes longer – The cobb angle correction or measures the degree of spinal curvature from normal is directly tied to brace wear duration. Therefore, wearing a brace for less daily hours usually means a much longer overall treatment duration.
Specific to smaller curve correction – Studies show that individuals with curves larger than 35 degrees (some studies show 25 degrees) require full time bracing. Night time bracing is not recommended for serious scoliosis cases and are not recommended for children that have more than a single curve to correct.
They may cost more money – Because night time braces are typically rigid braces requiring being molded and cast specific to the size of a child, multiple braces may need to be purchased over time because scoliosis typically is diagnosed in children from the ages of 10 to 15 years of age when they are going through their growth spurts.
The very nature of scoliosis is asymmetry, and most studies agree that asymmetric braces lead to better scoliosis correction.
A study in the National Library of Medicine found that “Asymmetric braces have led to better corrections than that described for symmetric braces”.
Another study concluded the following; “Symmetrical braces for scoliosis are outdated. Asymmetric braces allow better in-brace correction compared to symmetric braces.”
The answer is a bit more complicated than simply a yes, or no response. When children with moderate scoliosis receive a custom tailored treatment plan for their specific type of scoliosis, factors such as age, growth potential, and strict compliance to that treatment plan come into play. Typically, if they follow the treatment plan and are in compliance with the prescribed hours of use , more than 80% of children with adolescent idiopathic scoliosis will halt the curve progression. Their spine will not continue to curve abnormally once their growth plates (cartilage at the end of long bones which allow for growth) have closed or hardened into bone, which happens after puberty. So in a sense they will grow out of this abnormal curve once they've reached skeletal maturity.
Reaching skeletal maturity does not necessarily mean that they will not still have an abnormal curve. It simply means that the curve progression has been halted and remediated in such a way that it does not get worse while their spine is experiencing accelerated growth during puberty.