» Can Scoliosis Be Improved Through Bracing
Can Scoliosis Be Improved Through Bracing

Can idiopathic scoliosis (IS) be improved through bracing? That is a question that has been studied and debated for years. There are plenty of studies that conclude it is not possible, especially when the curve is more than 45 degrees in a growing child. But the results of this study may bring new information to that conclusion.

Idiopathic scoliosis refers to a curvature of the spine that has no known cause. The child does not have a neurologic or neuromuscular problem like muscular dystrophy or cerebral palsy that could account for this problem. Treatment in the past with bracing and exercises just hasn't been effective in large curves.

But the results of this new study from Italy show that in some children, the curve can be stopped and even improved with bracing and exercises. They claim the difference is in patient compliance (willingness to follow a strict program) and the use of good bracing. Oh yes, and time -- the program of bracing and exercise was followed for years (three to seven).

The group of 28 patients in question was older than 10 years. They were skeletally immature (i.e., still growing) and had at least one spinal curve that measured on X-ray as 45-degrees or more. Surgery (usually recommended for curves this large) was refused by the patient and family. That left the surgeon with no choice but to treat the curve conservatively as best as possible.

Each child was evaluated individually and prescribed one of three braces (Risser, Lyon, Sforzesco). Risser actually refers to a body cast used for scoliosis. The Sforzesco brace has since replaced casting. The two braces (Lyon and Sforzesco) are specifically designed for scoliosis.

The children were told to wear the brace everyday, all day (at least 23 hours/day) for a full year. After six months, the child could reduce his or her brace wearing time by two hours. And every six months after that, the brace wearing time could be decreased by two more hours until the child was weaned from the brace altogether.

At the same time, physical therapists helped the children with postural and stabilization exercises. This type of rehab program helps retrain motor control of the muscles. The goal was to maintain the correction received with the brace during and after the weaning time.

The idea behind this bracing/exercise/weaning program is that the slow method allows the postural system to adapt. The intended results are improvement of the curve and maintenance of any spinal correction achieved.

How well did it work? Three-fourths of the children improved by at least five degrees (and some by as much as 15 degrees). The curves that improved the most were in the lumbar spine (low back). Only one child got worse.

The authors conclude that it is possible to successfully treat scoliosis curves 45-degrees or larger without surgical fusion. It takes good patient cooperation over a long period of time. Motivation seems to be a central key to success with this type of conservative care. A team approach with involvement and communication among family, patient, surgeon, physical therapist, and orthotist (brace maker) is also essential.

Reference: Stefano Negrini, MD, et al. Idiopathic Scoliosis Patients with Curves More Than 45 Cobb Degrees Refusing Surgery Can Be Effectively Treated Through Bracing with Curve Improvements. In The Spine Journal. May 2011. Vol. 11. No. 5. Pp. 369-380.