Wednesday, November 9, 2016
Spine Bracing in Early-Onset Scoliosis (EOS)
Bracing in EOS is a commonly utilized nonsurgical intervention. Braces are constructed of either rigid or semi-rigid plastic, and are designed on an individual basis. The orthotist (the person who makes the brace) analyzes each patients’ anatomy and radiographic deformity, then constructs the brace. The brace is contoured to place pressure points on the ribs and pelvis, with padding, and that force is then transmitted to the spine, ideally straightening it.
In EOS one of the concerns of bracing is altering the rib development and alignment. Hence, most often brace use in EOS is not recommended to be worn full-time. Conceptually, having time out of the brace the chest can develop more normally. This is more of a theoretical concern, as there is little information that bracing can permanently deformed the chest in a negative way.
Though there are medical centers and providers which report, and sometimes advocate or market, for one brand of spine brace over another, there are three main types: flexible, semi-rigid and rigid. Flexible braces, typically constructed from a highly-elastic material like neoprene (with straps), may be appropriate for children with mild to moderate deformities and have low neurologic tone. This brace exerts less force to the spine so it cannot be used in patients with normal or increased tone or moderate to larger deformities. In my practice these have been used occasionally in the neuromuscular patient (cerebral palsy, spina bifida, spinal muscle atrophy, etc…) who are low demand physically and have low muscle tone. Semi-rigid braces are a step up in stiffness, and subsequently can exert more corrective force to the body and spine. These braces are more typically used in children under 3 years of age with milder deformities.
Rigid braces (TLSO: thoraco-lumbo-sacral orthoses) are the most commonly used brace in EOS and in spine bracing in general. There are several subtypes of rigid braces: Boston, Wilmington, Charleston, etc… which have different corrective forces and wear schedule. Regardless of which brace is used a key issue to brace is simply that the brace must be appropriately worn by the patient for the recommended length of time each day. A brace will not have the ability to help the patient if it not being worn. The goal of a spine brace is to maintain the deformity, not to correct the deformity. In EOS it can be used a primary treatment for milder, more flexible deformities or after a series of spine casts. It is difficult, if not impossible, to create a long-term plan for each patient, so the length of time each patient will need to be braced is difficult to determine.
Next blog post: Chiropractic treatment of scoliosis