What is the treatment approach for bracing in moderate scoliosis?

Bracing Protocol for Moderate Scoliosis

For moderate scoliosis (curves between 20-50 degrees in skeletally immature patients), bracing is the primary treatment approach to prevent curve progression and potentially avoid the need for surgery. 1

Indications for Bracing

• Documented curve progression of ≥5° on serial radiographs
• Curve magnitude between 20-50°
• Skeletal immaturity (Risser sign ≤2)
• Age ≥10 years

Bracing Protocol

Type of Brace

1. Boston Brace: Most widely used and effective rigid brace design

   • More effective at preventing curve progression than dynamic braces like SpineCor 2
   • Associated with lower risk of curve progression to surgical threshold

2. Alternative Brace Options:

   • Chêneau brace and derivatives (European design)
   • Milwaukee brace (for high thoracic curves)
   • Charleston bending brace (nighttime only)

Wearing Schedule

• Standard Protocol: 20-22 hours daily wear for maximum effectiveness
• Minimum Effective Time: 15-18 hours daily when combined with specific exercise program 3
• Regular wear until skeletal maturity (Risser sign 5 or growth <1cm in previous 6 months)

Monitoring and Follow-up

• Clinical assessment at least twice yearly
• Radiographic monitoring every 12 months (more frequently if progression suspected) 1
• Regular brace adjustments as needed for growth and curve changes

Complementary Approaches

Exercise Program

• Combine bracing with specific scoliosis exercises for better outcomes
• Exercise program should include:
  • Core strengthening exercises
  • Postural training
  • Spinal flexibility maintenance
  • Symmetrical muscle development 1

Results to Expect

• Average Cobb angle reduction of 5-12 degrees with consistent brace wear 3
• Best results in thoracic and thoracolumbar curves (10.17% and 6.36% reduction respectively) 4
• Improved balance parameters and reduced plantar pressure abnormalities 3

Common Pitfalls to Avoid

1. Delayed referral for bracing when curves are already approaching surgical threshold
2. Inconsistent brace wear - compliance monitoring tools should be considered
3. Neglecting psychological impact of bracing on adolescents
4. Overlooking non-idiopathic causes of scoliosis that may require different management
5. Using bracing as the sole treatment without complementary exercise program

Special Considerations

• Early and continued physiotherapy mitigates contractures and scoliosis progression 5, 1
• Chest wall bracing can have negative impact on vital capacity and decrease respiratory system compliance 5
• For patients with progressive curves, limit high-impact activities that increase asymmetric loading on the spine 1

Transition to Surgical Management

Consider surgical referral when:

• Curve progresses despite appropriate bracing
• Curve exceeds 40-45 degrees in an adolescent
• Significant pain, cosmetic concerns, or respiratory compromise develops 1

Bracing remains the most effective non-surgical intervention for moderate adolescent idiopathic scoliosis, with the potential to completely avoid the need for surgery when implemented promptly in skeletally immature patients 6.