Scoliosis and Spinal Bracing for Teens

Scoliosis and Spinal Bracing for Teens

Friday, 02 September 2022 09:04

As the body grows, it undergoes substantial changes, and sometimes those changes can be disproportionate. A common condition that arises out of growth spurts proceeding puberty is scoliosis. Although it can occur at any age, this range of 11 to 16 years old is when most diagnoses occur.


Scoliosis and Spinal Bracing for Teens

Characterized as a sideways curve in the spine, idiopathic scoliosis (meaning there is no underlying or known cause) affects 5% of all kids in the US, which is about 3 million cases per year. The majority of cases are mild and require no intervention aside from monitoring, but it can still be an anxiety-inducing scenario for parents and kids. 

In this article, we will take a look at the symptoms and diagnosis of scoliosis, different treatment methods, and then do a deep dive into pediatric scoliosis bracing. 

Symptoms and Diagnosis of Scoliosis in Kids

The vast majority of scoliosis cases are caught during regular doctor visits or during scoliosis screenings performed at schools. One such screening exam is the Adam’s Forward Bend Test. 

By bending forward at a 90-degree angle, unevenness in the position of the spine becomes prominently visible. If there is concern that there may be a curve to the spine, a complete diagnosis requires x-ray verification.

Your school and pediatrician will generally refer you to an orthopedic surgeon for this x-ray and for further discussion of the appropriate level of care needed. 

In most cases, the spine will begin to rotate or twist in addition to curving, causing visible differences in muscles and skeletal structure. There are a few additional signs you can be on the lookout for that may indicate scoliosis or other spinal alignment issues, such as:

  • A shift of the head to one side
  • One shoulder is higher than the other
  • Unequal arm gaps
  • Other marked posture differences between the left and right sides

Scoliosis is not typically painful and can happen to any kid and preteen, no matter how healthy and active. The best way to catch issues early is to be observant and listen if your child feels like something is amiss. Mild curves can develop into more severe cases if left untreated, leading to complications like difficulty breathing, back pain, and visibly uneven skeletal structure.

Treatments for Scoliosis

Treatment for scoliosis can be parsed into three categories: observation, bracing, and surgery. Which type of treatment is recommended by your diagnosing orthopedic surgeon will depend on the severity of the curve. It is important to note that scoliosis will not resolve on its own; it can be treated but not cured.

If the spinal curve is less than 20-25 degrees, no direct intervention is generally taken, but the orthopedic surgeon will want to observe for any continuing changes. While growth is still occurring, the doctor will recheck with a new set of x-rays that the curve is not becoming worse. 

You may wonder why no actions are taken to help treat these minor curves. Generally speaking, such a slight curve will have little to no impact on the body, and as long as the angle isn’t progressing, no action is needed. Once fully grown, most scoliosis curves under 30 degrees tend to remain the same for life with no additional required treatments or side effects.

When the spinal curve hits the 25-45 degrees range as determined by x-ray, you will likely face a recommendation for the use of a scoliosis brace. We will go into more about scoliosis braces and how they work below, but most people with scoliosis never have to wear a brace. Only about 1 of every 6 cases progresses to the point of needing braces or surgery.

Speaking of surgery, this treatment only occurs in the most extreme of cases when the curvature is 50 degrees or more. 

Surgery involves a spinal infusion that will help straighten out the spine, but it cannot make a spine completely straight. And the procedure stiffens the spine making movement more difficult. For this reason, spinal surgery only occurs in severe cases where the curve impedes the quality of life and will continue to worsen.

All About Scoliosis Braces

Scoliosis braces work by providing pressure to specific areas of the back to counteract a curving spine. The brace removes pressure on the inner part of the curve and increases it on the outer section. 

While the brace is worn, the curve can be partially or fully corrected, and this additional support works to keep the curve from worsening. When the brace is removed, the spine will return to its curved state. 

Bracing does not provide a permanent straightening of the spine; but rather, the goal is to prevent the need for any further action. Once the body reaches adulthood and has stopped growing, the need for bracing also stops. So long as the angle of the curve stays below 40 degrees, there is a low risk of it developing further deformity through adulthood.

There are two types of scoliosis braces: a rigid brace and a soft brace. 

Rigid braces are the most common and are a plastic shell lined with foam that almost entirely encompasses the upper body from the armpits to the pelvis. 

Soft brace styles utilize elastic straps and velcro to achieve the same results. Both types generally feature straps that allow for easy removal.

Rigid braces are naturally more cumbersome to wear and take longer to acclimate to. It was out of this and the issue of non-compliance that soft style braces were created. But more rigid styles provide more significant support, so if they can be tolerated by the child without compliance issues are the most common choice. 

No matter which style your orthopedic specialist recommends, you will need to have the brace custom fitted. Everyone's bodies are different, and the brace needs to be tailored fit to address the location and severity of the spinal curve. The other part of scoliosis bracing that will be specific to the patient is the duration of wearing the brace daily.

Nighttime v. Fulltime Bracing

nighttime versus fulltime bracing

Brace compliance is critical, especially since timelines for treatment often span 1-3 years. While you won’t be expected to wear the brace 24 hours a day, make sure you have an honest discussion with your orthopedic specialist about the activities your kid takes part in, like sports.

Nighttime bracing is exactly how it sounds, with the goal for the patient to focus on wearing the brace for 8-10 hours over the evening and overnight hours. Full-time bracing encompasses wearing the brace for 16-20 hours every day. 

Higher success rates have been repeatedly shown when full-time bracing compliance is over 17 hours per day. But don’t discount nighttime bracing if your kid is comfortable sleeping in the brace, as it can maximize the correction with fewer hours. Nighttime braces are designed to provide more force to the spine as the individual won’t be sitting or walking with them on and are more restrictive of movement.

Acclimating to Scoliosis Braces

A big part of keeping up with brace compliance is comfort and fit. Every brace is custom-tailored to the patient's body, but it still takes a number of weeks for your child to become accustomed to wearing the brace for more extended periods of time or when sleeping. For this reason, there is generally a gradual ‘breaking-in’ schedule to get up to the total required hours. 

It isn’t uncommon to see some redness or sore feeling when acclimating to the brace. However, if you note any blisters or sores, contact your orthopedic specialist as the fit will need to be adjusted. 

Getting used to putting on and taking off the brace solo can take some work, but after practice should be something your kid can handle solo when getting dressed or bathing. One aspect of compliance is normalizing wearing the brace in everyday circumstances. Looser-fitting clothes often entirely hide the brace when worn, making it impossible for others to know it is there.

And if it seems like movement might be impeded with the brace on, they are generally expected to be taken off for sports and other physical activities where restricting movement can be even more dangerous. Be patient and slowly work it into a regular routine.

Like anything that sees daily use, braces do wear out. Coupled with physical growth spurts, scoliosis braces are usually replaced every 12 months for full-time sets and 18 months for nighttime. Every 4 to 6 months, you will have a follow-up with the doctor to check the state of the brace and the effect your continuing growth has had on the scoliosis.

Pediatric Orthotic Specialists

A scoliosis diagnosis and the need for long-term bracing can seem like an insurmountable task at first, but you won’t be going it alone. If your child’s pediatrician has recommended pediatric orthopedic bracing for scoliosis or other mobility concerns, Orthopedic Appliance Company can help. We have provided Asheville residents with the highest quality custom pediatric orthotics since 1960.

Our facility and practitioners have met the rigorous standards and are certified by the American Board for Certification in Orthotics and Prosthetics. For children, orthopedic bracing must grow with them. We work with you, your child’s pediatric and rehabilitation teams and their unique needs to develop braces that will work with not against your child’s development.

We have three convenient locations in Asheville, Fletcher, and Hickory, with more to come. Check to see which is closest, or send us a message with your concerns and location, and we will get you to the right place.