Scoliosis Braces in Depth

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A study on available adolescent scoliosis research showed that scoliosis braces, as a treatment for adolescent idiopathic scoliosis, “consistently showed that bracing prevented curve progression”.

Idiopathic scoliosis is a 3 dimensional deformity of the spine. Scoliosis is called idiopathic when the underlying cause, or origin can not be determined. Idiopathic Scoliosis occurs in 80% of all Scoliosis cases, and Adolescent idiopathic scoliosis is the most commonly diagnosed, of the idiopathic types.

Braces are used for treating scoliosis as they are considered an effective method in treating almost 80% of all scoliosis cases. As the most widely used treatment plan for idiopathic scoliosis, use of a brace is the primary method of stopping a curve from getting worse in children. Scoliosis specialists prescribe a brace to correct a scoliotic spine in an effort to help kids' curves from getting worse, and help children avoid spinal fusion surgery. 

The following braces are available on the market (read further to get more detailed information);

• Milwaukee Scoliosis Brace
• Wilmington Scoliosis Brace 
• Boston Scoliosis Brace
• Charleston Bending Scoliosis  Brace
• Rigo-Cheneau Scoliosis Brace
• Providence Scoliosis Brace
• SpineCor Scoliosis Brace.
• Scoliosis Activity Suit 
• Scolibrace 
• CMP Brace

This is the first brace invented specifically to treat scoliosis in 1958. This is a jacket-style brace which is meant to be worn up to 23 hours per day. The Milwaukee brace is a corrective spinal orthotic brace made up of a neck ring with a throat mold. 

Additionally, it has two occipital pads which help to avoid high pressure in the neck region. Finishing out the brace is a plastic pelvic girdle with aluminum uprights, and leather L-shaped thoracic pads, and metal bars along the front, and back. 

Because it's so difficult to wear physically, and so obtrusive visually, this brace is rarely used anymore. This particular brace is considered one of the most uncomfortable. The newer profile braces, using 3d cam/cad type manufacturing and design are now prescribed, and have replaced this type of brace, except for a few illness specific cases.

In 1969, the chief of service at the DuPont Institute, recommended the Milwaukee brace (which looks like a medieval girdle) for the treatment of a young girl with scoliosis. She absolutely refused to wear it, and as a result of that refusal, MacEwen set out to create the first low-profile TLSO’s (Thoraco lumbar Sacral Orthosis). This low-profile brace became known as the Wilmington brace. 

A Wilmington Brace is a jacket-style brace that treats moderate curves which start at the  rib cage and lower spine. This type of scoliosis brace has an excellent history of treating scoliosis, and research to back up its success rate when used properly. Child compliance in wearing the rigid jacket-style brace Can be an issue compared to other braces, especially dynamic and flexible braces that are not very conspicuous like the Spincor scoliosis brace.

This type of brace will fit under clothing and cover the entire upper body from the hips to the armpits. It is made from lightweight rigid plastic, often PE (polyethylene), and is custom made to fit to a child’s body.

This is a custom made orthotic scoliosis brace which closes in the front, and is made by creating a plaster mold from the child’s torso. From that plastic mold, the brace is created using lightweight plastic. The technician that creates this mold is called an Orthotist. 

Unfortunately, as in any craft, the end product is only as good as the training and experience of the technician. The potential for discrepancies and quality control from one orthotist’s finished brace to another has been researched and documented as a concern and a disadvantage of this type of brace.

However, with newer manufacturing and design techniques employing computer aided design and manufacturing , the variances in standardization from orthotist/ scoliosis brace craftsmen in the plaster mold making, a pitfall in this type of brace, was effectively resolved.

Just a few years later, in 1972, John Hall and an  orthotist, William Miller, from Boston Children’s hospital, also created a low-profile TLSO jacket-style brace, which closes in the back.  Because the plaster casts could vary due to the expertise of the orthotist, and there was not a true standard, these two creators made one major change. They no longer required a mold to be custom made per child. 

They  essentially created prefabricated modules of different sizes which were then modified and custom fit to each individual child, specific to the patient’s deformity.

They prefabricated six standardized modules based on a range of sizes to fit the majority of children. By custom modifying the prefabricated plastic molds and making them more comfortable and standardizing the fabrication of the molds, the Boston brace has become one of the more popular treatment methods for children with scoliosis. 

The ability to use these “modules” in a more standardized fashion, and not having to rely so heavily on the experience of an Orthotist and his plaster molding capabilities, have made this type of brace easier to implement and modify, compared with the Wilmington brace. Because of this ease of implementation and modification, the Boston brace has become one of the most widely prescribed treatment plans for adolescent idiopathic scoliosis.  It is important to note that although it is one of the most widely prescribed treatments in terms of scoliosis braces, it does not mean that it Does not have any drawbacks. Taking prefabricated molds and using a “few” sizes fits all approach Is a major drawback. It follows that when you take pre-manufactured molds, and you try to generally fit children with different curves, angles, body shapes, and underlying scoliosis types, you're going to have some mismatches. Braces that were developed just three and four decades later, employing computers using 3D manufacturing and design techniques, more specifically address the uniqueness of each child's underlying curve/ curves. 

A key difference in the Charleston Bending Brace is that it is made to be used at night and shaped to “overcorrect” an abnormal curve by forcing the spine to be bent to one side while sleeping. 

Just like daytime jacket-style bracing, it consists of a solid piece of plastic that holds the back in position at night, instead of trying to keep the person upright and elongated through the spine during the day. This type of brace usually only works for children with C-shaped curves in the lower back or lumbar region. 

It is important to note that this brace takes longer to correct a curve in a scoliotic spine due to being worn less hours per day. Furthermore, studies show that this type of brace is not as effective at helping to prevent progression of the curve as compared to a full time brace. The study showed that a full time brace is about twice as effective as a night time brace in avoiding spinal fusion surgery. Lastly, this type of brace is really only recommended for single curve scoliosis with curves measuring less than 35 degrees from normal. 

The Rigo - Chêneau brace is a custom-made plastic, thoracolumbar sacral orthosis (TLSO) which has open areas that allow the child’s body to expand during breathing, and any physical exercise. Although the original  Rigo - Chêneau brace was developed in 1979, there have been many variations based off of the original. Most recently, the use of 3D cad/cam design and manufacturing has allowed for the digital scanning of each individual's body, allowing for the creation of specific contact and expansion points in a three dimensional model that do not rely on an orthotist’s skill set. These types of braces are made of lightweight plastic for increased user comfort.  They are often combined with the Schroth physical therapy method which emphasizes breathing, muscle synergy, stretching, and posture awareness. 

Of particular interest is the fact that this front opening brace is not only considered rigid, but dynamic at the same time, due to its expansion points, and specific contact points, where it addresses the curve progression in the scoliotic spine.

The Providence Scoliosis brace was developed in 1992. It's a custom fit night time use brace which uses 3D cad/cam (Computer aided design /computer aided manufacturing) technology. It is made of a hard plastic called polyethylene. This scoliosis brace is very similar to the Charleston brace,  but it applies a different type of correctional force. It was developed to ensure better wear compliance by children with Scoliosis and adherence to their prescribed scoliosis treatment plans. 

This particular type of brace is best used for patients that have curves that are less than 35 degrees in lumbar, and thoracolumbar cases,  according to research. This is considered a TLSO (Thoraco Lumbar Sacral Type Orthosis) brace that is strictly used at nighttime. It is designed in such a way that it helps decrease the risk of progression of secondary curves per research by the National Institute Of Health. It is designed to move the spine to the midline with direct force to the scoliotic curve. 

When children have a curvature of about 25 degrees or more, pediatric orthopedic doctors typically recommend scoliosis bracing for children and teens, provided they are still growing. Although children using scoliosis bracing can achieve curve reduction, the primary goal of the bracing treatment is to stop, or keep the curve from progressing to the point where spinal fusion surgery becomes necessary.

A scoliosis specialist should prescribe the least aggressive and invasive option to help your child, taking all factors into consideration already discussed- age, growth, and scoliosis type. So, for the majority of children diagnosed with this issue, only monitoring for changes in the curve and verifying for any worsening or progression of the curve is the best course of action. Then, for moderate scoliosis, anything greater than a 25 degree Cobb angle, the treatment plan typically includes scoliosis bracing. Lastly, for those with moderate or severe scoliosis, spinal fusion surgery may be required.

The Spinecor brace was developed in 1998 out of a study commissioned in Canada.It is the first truly dynamic brace,  and is the latest and most recent innovation in comfort and flexibility. This is a very flexible, “dynamic” brace which consists of a thermoplastic pelvic base, nylon shorts, a cotton bolero, and four, variably sized elastic bands. Charles Rivard and Christine Coillard at Saint-Justine Hospital in Montreal, Quebec created the brace to address three underlying issues associated with scoliosis; postural disorganization, muscular dysfunction, and un-synchronized spinal growth. The basis for the brace was that by controlling the spinal movement in the brace it actually prevents, and/or improves spinal deformity by specifically addressing these three factors.

The physician uses a software system to determine the placement, as well as the tensioning of the bands, specific to the curve of the patient. Due to its streamlined nature (that is hardly noticeable under clothing), teenagers are highly compliant in wearing the brace for up to 22 hours per day. They are typically given a two hour break from the vest, one hour in the morning, and one hour in the evening. Unlike most braces that are not adjustable after the initial fitting, the Spinecor brace is designed for adjustments with each visit to the physician. The physician can quickly and easily tighten, or loosen the bands. After taking x rays, which are used to monitor the curve over time, the scoliosis specialist can methodically reshape the spine and halt the curve progression based on the x ray results.

As the treatment plan progresses, the doctor can apply more, or less pressure in problematic areas, effectively working against the curve where needed. This is a huge advantage over a static, rigid brace that is heat molded into a final shape for the curve abnormality, and remains fixed throughout the entire brace treatment plan. It's really important not to overlook the simplicity of this design but the genuine advantage over hard rigid braces that is allowed with the elastic bands being used to immediately adjust the amount of pressure applied at the apex of the scoliotic spine in real time, based on X ray results, from examination to examination. Compare this to a rigid brace that only has one opening in front or back that does not allow as much dynamic range of motion, nor adjustment to address a changing or increasing progression of the apex of the curve as easily. This is a distinct advantage as it represents a real time brace correction for immediate adjustment after an x ray.  Should there exist a need to significantly change a rigid brace because the level of correction is insignificant, for example, the cost of the treatment plan essentially doubles for the brace portion. With a flexible Spinecor brace, no additional braces need to be manufactured, therefore saving money in the long run. 

Another significant advantage remains in the fact that this is a very flexible cloth brace, as opposed to a rigid brace whereas if a child gains or loses a significant amount of weight, a rigid brace may not allow for that growth, especially during puberty. A child's body changes tremendously during puberty which is when most adolescent idiopathic scoliosis cases are discovered. During this rapid growth , their bodies may elongate and become skinnier, or as is the case with some children, they may become bulkier and more muscular, or simply gain more fat and grow out of a brace. Should this growth variance be significant , it would necessitate manufacturing a larger rigid brace . With a Spinecor brace, the possibility of this additional cost is not even a consideration.

This brace allows patients with as small as a 15 degree curve to use it for correcting, or halting curve progression, instead of mere observation. Unlike other braces that monitor until a scoliotic curve progresses into the lower 20 degree Cobb angle, or even 25 degree Cobb angle,  the Spinecor brace begins to address the issue much sooner, rather than take a "wait and see" until it gets worse approach.

The latest scientific studies and methodologies show that using the Spinecor brace “resulted in curve stabilization or improvement in 59% of patients using the new SRS Inclusion and Assessment Criteria for Bracing Studies''. This new standardized criteria was proposed by the Scoliosis Research Society Committee on Bracing and is the latest criteria being used in research studies on Scoliosis braces. The study found that the SpineCor brace is effective in treating adolescent idiopathic scoliosis. 

Another study concluded “that the effectiveness of the SpineCor orthosis in obtaining and maintaining the neuromuscular integration of the corrective movement can be achieved effectively for juvenile patients.” 

More importantly, the study found that over 75 percent of children that completed the treatment protocol remained stable even after the Spinecor brace was no longer used.  Finally, they concluded that the SpineCor orthosis was a “very effective method of treatment of juvenile idiopathic scoliosis.”.

Further research showed that using the spinecor brace continued to result in positive outcomes and the patients maintained them even “after 2 years because 151 (93.2%) of 162 patients stabilized or corrected their end of bracing Cobb angle up to 2 years after bracing.”

Additional research has shown that The SpineCor System “is the first and only truly dynamic brace, which provides a progressive correction of Idiopathic Scoliosis from 15 degrees Cobb angle and above”. As mentioned before, this is a unique feature in that it allows patients with 15 degrees to 25 degree curves to begin actively halting curve progression instead of the typical “wait and see” if the curve worsens approach which is prevalent in the industry. Another significant advantage to this type of brace is that it is made entirely of some cloth and is comfortable brace to wear, and therefore treatment plan compliance is very high amongst all children, including preteens, teens, and adolescents. 

The Scoliosis Activity Suit was evaluated by a scientific study in 2020, and they concluded that “ it is more accurately thought of as exercise equipment as compared to an orthosis”. Furthermore, they concluded that because it is designed to be used “in an attempt to increase postural muscle effort, particularly those muscle groups opposing the abnormal scoliosis rotation”, it is not to be considered an orthotic device such as a Scoliosis brace.