Scoliosis and Teens: How a Back Brace Can (and Can’t) Help

Answers to common questions from an orthopedic surgeon

If your adolescent has been diagnosed with scoliosis, your doctor may have recommended that your child wear a back brace.

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It’s important to take your physician’s advice seriously; if left untreated, scoliosis can lead to permanent deformity, disc damage and neurological damage.

And braces can help. A 2013 study showed that the more hours a day a child wears a brace, the less the spine curvature worsens. Wearing the brace 13 hours a day or more worked best, the study showed.

In this Q and A, orthopedic surgeon Ryan Goodwin, MD, answers questions about back braces to treat scoliosis in adolescents.

Q: What is the most important aspect of the brace that makes it most effective for teens? Brand? Amount of correction? Or length of time wearing it?

A: Perhaps the most important component of brace effectiveness is complying with the recommendations for wearing it. There is good evidence that suggests that if patients wear their braces according to the recommended guidelines, the braces are significantly more likely to be effective than for patients who do not follow the guidelines.

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The amount of in-brace correction is likely less important. That being said, an in-brace X-ray should show some correction of the curvature in brace to confirm that it can potentially be effective.

The bottom line here is that if the patient is a candidate for a brace, he or she must have a brace that does improve the curvature somewhat on an X-ray, and it should be worn according to the prescribed guidelines as much as possible.

Q: Is there research to show that wearing a brace improves a child’s spine? Or does it just keep the spine from curving more?

A: To date, no medical evidence suggests that any brace can improve a patient’s curvature.

Occasionally, we may see an effect on an X-ray when a patient has been wearing a brace with some regularity. Ultimately, however, the brace cannot improve a patient’s curve.

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There is good evidence that a proper brace can slow down the progression of a curve in a growing child. Success rates are anywhere between 50 percent and 85 percent, and are very closely linked to patient compliance with wearing the brace.

Q: How many hours should my teen wear the back brace for the best result? Does wearing it longer mean a better result?

A: The brace wear schedules are different for a Boston-type brace, which is worn during the day, and a brace meant to be worn at nighttime such as the Providence brace.

The evidence would seem to indicate that a minimum of 16 hours to 18 hours of brace wear can produce the desired results in a Boston-style brace. There does not seem to be significant evidence that increasing this improves things significantly. Wearing the brace less than six hours a day is ineffective and is like not wearing the brace at all.

There is less evidence on the nighttime bending brace; however, compliance tends to be quite good with them. They work differently and there is less brace wear— the patient only wears it when he or she is sleeping. The evidence here, however, suggests that if worn nightly, the bending brace can be effective at slowing curve progression in a majority of patients as well. The nighttime brace is a good option for those who have trouble getting enough hours of Boston brace wear daily.

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