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Frequent Asked Questions

(Answers based on SOSORT's Guidelines and Consensus)

 

1. Is the effectiveness of bracing in adolescent scoliosis (Adolescent Idiopathic Scoliosis) scientifically proven?

2. The early onset scoliosis have a strong evolutionary prognosis, why a brace if ultimately surgery is necessary?

3. Is there an alternative to the brace for toddlers children?

4. If the brace is effective why not use it as soon as scoliosis is confirmed (more than 10 °)?

5. Are there any tests that can predict the progression of scoliosis from a small angle?

6. What impact does time wearing the brace have at the start of treatment?

7. What will determine the wear time of the brace after the initial full-time prescription?

8. What will determine the duration of treatment and the weaning of the brace?

9. What can promote bone mass and stability of scoliosis?

10. How to control the quality of a brace?

11. Does brace treatment require special expertise?

12. Who are the main members of the orthopaedic team?

13. What are the stages of the creation of a brace?

14. What are the criteria to make a brace?

15. Scoliosis is a three-dimensional deformity with a tendency to flat back. Is there a risk for the brace to accentuate the flat back?

16. What are the criteria for brace tolerance?

17. May the brace limit the development of the thorax and therefore of vital capacity?

18. Is it necessary to be hospitalized for a scoliosis brace?

19. Why is there an upper limit angle of about 40 ° to use a brace?

20. Why braces cannot completely correct scoliosis?

 

1. Is the effectiveness of bracing in adolescent scoliosis (Adolescent Idiopathic Scoliosis) scientifically proven?

Yes - from the partially randomized BrAIST and other complementary studies, the effectiveness of the brace is now proven for AIS.

 

2. The early onset scoliosis have a strong evolutionary prognosis, why a brace if ultimately surgery is necessary?

With conventional spinal fusion surgery, the metallic material is not growing along the column. The number of occasions for the elongation of the material is limited and the surgery does not completely straighten the spine. Thus the use of bracing to postpone surgery has major benefits.

3. Is there an alternative to the brace for toddlers children?

Yes successive plaster casts (serial casting) using the technique of Min Mehta

4. If the brace is effective why not use it as soon as scoliosis is confirmed (more than 10 °)?

- Bracing is not a passive device. It has multiple side effects: physical, psychological, financial...

- The incidence of idiopathic scoliosis between 10 ° and 20 ° is 2% of the adolescent population, but the frequency of scoliosis of more than 20 ° is 0.2%, that is to say, only 10% of scoliosis is subject to progress.

- Unnecessary bracing of 90% of scoliosis is questionable. It’s an over-treatment.

-  When research has been carried out for bracing between 10 ° and 20 °, to reduce the curve below 10 °, results were seen as a failure.

- The progression of scoliosis of less than 20 ° is chaotic, like an earthquake or an avalanche, that is to say, unpredictable.

 

5. Are there any tests that can predict the progression of scoliosis from a small angle?

Different testing: genetic, biological and radiological signs of severity are being studied, but none are used systematically at present.

The test with greatest reliability is to under regular and systematic checks at intervals defined according to the risk of progression by age (between 3-6 months). If scoliosis worsens over 5 ° between two successive examinations, brace treatment could be considered.

 

6. What impact does time wearing the brace have at the start of treatment?

- At the start of the treatment, the patient’s spine is the most flexible. Thereafter it will stiffen. It is better to stiffen in the best possible corrected position.

- The asymptote of the curve is 24 h / 24

- In all scoliosis, there is a shortening of the concavity ligaments. Physiologically, to be able to exceed the threshold of elasticity and lengthen the elements of the concavity (plastic deformation), you must perform a continuous tensile load for several weeks.

- For skin sensitivity reasons, the permanent wearing is better tolerated than the partial time. This is the effect similar to that of a "wrist watch" that we do not feel the alteration under permanent wear.

 

7. What will determine the wear time of the brace after the initial full-time prescription?

Factors that your Scoliosis Specialist must evaluate are multiple.

 In order of importance:

- Cobb angle of scoliosis in the frontal plane: The larger the angle, the larger the pressures are in the concavity and thus the higher risk of bone deformation.

- Bone age: The younger the child, the more fragile the bone is and thus more the easily it may be deformed (vertebral wedging).

- The evolution of scoliosis in brace: If scoliosis is stable between two successive examinations, one can discuss a reduction of the prescription time during the day.

- Treatment goals: It may be less strict if the goal is just to postpone the time of surgery (awaiting treatment).

- Compliance (the physical and psychological tolerance of the brace): This tolerance gradually decreases during treatment. For the same reasoning, less corrective braces remains effective if worn continuously. But a more corrective brace can be worn less time in the day.

 

8. What will determine the duration of treatment and the weaning of the brace?

The first element is the patient’s growth: The end of growth is on average 15 years old in girls and 17 in boys.

The second element is bone strength: Bone mass is established between 15 and 20 years in girls. It is difficult to assess the strength of the vertebral bodies, so the removal of the brace is usually done gradually to evaluate control of correction.

 

9. What can promote bone mass and stability of scoliosis?

In general, children who undergo physical exercise have better bone mass and the brace may be removed earlier.

Physical therapy can also be useful at this stage focusing on the stabilization exercises and neuro-motorial integration.

 

10. How to control the quality of a brace?

The only proven brace control is through an in-brace X-ray,

The two main elements are:

- The percentage of angular reduction (the alignment of the spine). This reduction depends on the flexibility of the scoliosis, but also the effectiveness of the brace (rigidity, symmetry ...)

- The overall balance of the brace, which may require some adjustments such as the establishment of pads.

 

11. Does brace treatment require special expertise?

A patient should always be given freedom of choice considering a specialist physician and CP (Certified in Prosthetics and Orthotics).

But there are criteria of expertise both for the physician and the CPO.

These expertise criteria are based on: training, duration of practice, the number of scoliosis braces made and monitored weekly. Some are more specialized than others. It is the role of your GP to send you to a specialist doctor in your area who himself will advise you the most competent CPO according to the type of brace.

In case of doubt, the list of SOSORT members, which can be viewed on the SOSORT website, is a first indication.

 

12. Who are the main members of the orthopaedic team?

The strength of the chain is that of its weakest link.

The three main professions involved are: the specialist physician, the CPO and the physiotherapist who sees the patient every week.

There are no miracle methods, but some physiotherapists are more specialized than others. In North America the Schroth method is the most commonly used.

 

13. What are the stages of the creation of a brace?

1 - The prescription of the corset made by a specialist physician

2 - The moulding of the brace that can be made with plaster or with a computer (CAD/CAM system)

3 – The fitting of the brace. At this stage, the trim lines are defined.

4 – The correction of the brace. The exact closure is determined at the brace setting.

5 - The first control is performed by the physician with a radiograph.

Subsequently the corset will be reviewed regularly every 4-6 months.

 

14. What are the criteria to make a brace?

It is not the child who must fit to the brace, but the brace that must fit to the scoliosis.

The criteria for prescription are multiple. Depending on the number, the type of curves and their angulation, one can choose:

- The rigidity of the material, the largest curvatures are treated by the most rigid materials.

- The external asymmetry or internal pads.

 

15. Scoliosis is a three-dimensional deformity with a tendency to flat back. Is there a risk for the brace to accentuate the flat back?

Indeed, the extension of the spine tends initially to reduce the physiological lumbar lordosis and thoracic kyphosis. Currently there are ways to limit the accentuation of a flat back. The sagittal (sideways) profile of a patient must always be considered.

16. What are the criteria for brace tolerance?

he more the brace is tolerated, the better it will be worn.

Asymmetry with expansion zones allows a mobility of the spine in the direction of the correction.

The rigidity implies more precision in construction, but the main factor is the tolerance to hardness, that is to say the absorption capacity to impact the surface of the plastic. For example, a polycarbonate brace may be rigid, almost unbreakable, but has a low hardness.

The distribution of pressures through the largest possible area.

The adjustability of the brace.

 

17. May the brace limit the development of the thorax and therefore of vital capacity?

One of the main aims of scoliosis management is to prevent respiratory consequences in case of progression of the spinal curvature.

Adjustable and correctly adjusted braces are important when considering thoracic asymmetry and costo-vertebral joints

Rehabilitation through respiratory training is also important for improvement of lung function.

18. Is it necessary to be hospitalized for a scoliosis brace?

Everything depends on local conditions and the condition of the child, but given the current technology, most scoliosis braces are performed as an outpatient.

19. Why are there an upper limit angle of about 40 ° to use a brace?

We have seen that more the angulation, the greater the distorting pressures are at the concavity.

Even in adulthood, remodelling occurs within your body to reshape the bone (we change bone mass every 7 years in adulthood) and thus scoliosis will continue to evolve in adulthood.

Between 20 ° and 40 °, the increase is 0.5 ° / year, yet for scoliosis of more than 40 °, this evolution is on average about 1° / year.

Only some highly rigid braces have the opportunity to stabilize scoliosis of more than 40 ° and these require specific training and technology.

 

 

20. Why braces cannot completely correct scoliosis?

Mechanically, the brace does not act directly on the spine. It reduces the mechanical stress and resizes the paravertebral ligament tensions. This then allows time for the development through the growth cartilages to be balanced.

The growth cartilage often does not have time to re-form a rectangular vertebral body and thus the final result depends on the initial spinal deformity.

Surgery acts directly on the vertebral body and can therefore more easily correct spinal deviation. By contract, it does not directly model the deformation of the rib cage. Sometimes surgery and brace can work together.