d357fb02-c287-35d8-a1ef-ac9782f01ad5You’ve seen us do the drill in the office for your preadolescent and adolescent child: “Turn around, stand straight, keep your legs straight, bend over and touch your toes.”

While about three percent of children less than 16 years of age develop adolescent idiopathic scoliosis, only one-half percent or less have curves that require treatment. Severe scoliosis (curves approaching 50 degrees) usually requires surgery to prevent problems into adulthood.

A new study in the New England Journal of Medicine looks at the effect of rigid back bracing in preventing the progression of significant scoliosis (a curve greater than 20 degrees in a child who is skeletally immature).  This is how bracing works:

Treatment with rigid bracing (thoracolumbosacral orthosis) is the most common nonoperative treatment for the prevention of curve progression. There are many different brace designs, but with all of them, the objective is to restore the normal contours and alignment of the spine by means of external forces and, in some designs, the stimulation of active correction as the patient moves the spine away from pressures within the brace.


Let’s cut to the chase:

In conclusion, bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. Longer hours of brace wear were associated with greater benefit.


An accompanying editorial in the NEJM hits the pause button while pointing out that nearly half of the patients who were untreated also had a successful outcome:

The decision to commit a 12- or 13-year-old patient to several years of brace wear requires careful consideration of both the benefits and the downsides. Although brace wear in adolescent idiopathic scoliosis does not have the serious physiological side effects that are apparent in poliomyelitis-related scoliosis, it carries financial, emotional, and social burdens that need to be considered.


I’m sure there are inventors hard at work right now designing effective rigid back braces using modern, space-age materials that will be better-tolerated and accepted by young teens.


(Yahoo! Images)