Bracing Early-Onset Scoliosis

Spine Bracing in Early-Onset Scoliosis (EOS)

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. 
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.
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.  
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.
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