A scoliosis diagnosis can be worrying for both children and their parents. But it is important to remember that most cases are mild and don’t require bracing or surgery. For those with more significant curves, or curves at risk of progression, bracing can be a highly effective treatment. Our goal is to provide a comprehensive understanding of scoliosis and how it can be managed by modern bracing techniques, offering peace of mind and the best possible outcome for your child.
Scoliosis is a twisting, or torsion of the spine. It happens in 3-dimensions, with the affected vertebrae moving laterally, rotating and extending.
The resulting curvature may develop gradually, but often progresses during a growth spurt, such as around the time of puberty.
There are different types of scoliosis: Idiopathic, congenital, neuromuscular and degenerative.
The most common form is adolescent idiopathic scoliosis (AIS), which is diagnosed between the ages of 10 and 18. The term “idiopathic” means the cause is unknown.
Early detection & appropriate intervention are crucial to avoid problems in later life.
Bracing is the most common non-surgical treatment for scoliosis.
The decision to brace is based on several factors, including your child’s age, the degree of the spinal curvature (measured in degrees using the Cobb angle), and the remaining growth potential of the child.
Typically, bracing is recommended for children and teens with a Cobb angle between 25 and 45 degrees who are still growing. In some cases, it is appropriate to intervene earlier, particularly if the curve has a high likelihood of progressing. We also occasionally brace curves greater than 45 degrees.
The aim of the brace is to alter the configuration of the spine by changing the way it grows over time. This is called ‘growth modulation’.
By applying pressure to the body in certain areas and leaving space (expansion zones) in others, a brace may prevent the curve from progressing to a point where surgery becomes the only option.
Research has shown that bracing can significantly reduce the need for surgical intervention.
The process of getting a scoliosis brace is a partnership between the child, their family, the doctor, and the orthotist. It’s a journey that requires patience, understanding, and open communication.
The first step is a thorough clinical and radiographic assessment by a surgeon or doctor. This includes a physical examination as well as full spine X-rays taken from the front and the side. This information is then used to determine the best course of action.
If bracing is recommended, your surgeon will refer your child to a specialist orthotist.
Your orthotist will perform a thorough clinical examination and look at the x-rays to determine what design features are required for the brace.
They will then take measures and clinical photographs before capturing the exact body shape using a non-invasive 3-D scanner.
Children who are not suited to scanning (such as very young children, or those who are unable to sit or stand still for 6-8 seconds) may have a mould taken using Plaster of Paris to capture the body shape.
Every scoliosis brace is individually designed & manufactured. Our partnership with Neja has enabled us to use the most recognised de-rotation brace in the world, the Rigo-Concept brace, in our clinic.
Neja is a specialist orthotic company who have been using cutting edge CADCAM technology for many years to design top quality braces. With Dr Rigo advising directly on many of our cases, and Dino Gallo supporting us clinically, we truly believe that our service is built on the shoulders of giants.
The RC brace works on each level of the spine right down to the pelvis, re-organising each section by rotating and shifting it relative to the adjacent one in order to correct and rebalance the spine.
Certain areas of the brace will fit very snugly, while other areas will appear roomy, a deliberate design feature which allows us to apply gentle pressure to prominences while giving space to facilitate expansion of ‘collapsed’ zones.
During fitting the brace is adjusted to ensure that it is offering effective correction and causing as little discomfort as possible. We will teach you and your child how to put it on and take it off and provide clear instructions on the wearing schedule.
A review will be carried out 6 weeks after the brace is fitted when adjustments will be done to reflect any changes that may have occurred in the spine.
Your child will then be ready for an in-brace x-ray.
It is important to document your child’s growth at regular intervals.
As your child grows, the brace will need to be checked for fit and function.
It may be adjusted when it is no longer offering optimal correction or replaced when it has been outgrown.
This ensures that the brace remains effective throughout the treatment period.
Your child will be monitored by their surgeon, with regular clinical assessments and X-rays every 4-12 months.
It is vitally important that you keep us informed every time your child has an x-ray so we can keep an eye on their progress.
The success of a brace depends on several factors;
The more flexible the spine is the more amenable it is to correction. Stiffer spines with higher torsion are less accepting of correction, however a brace may be used to slow down progression.
The amount of growth remaining will have an effect on the outcome……If a child is almost finished growing, there is less time for the brace to change the spine.
The number of hours a brace is worn per day will have a bearing on how effective the brace will be. The brace can be removed for sport but should be worn for the recommended number of hours per day for best results.
The type of brace used will determine its effectiveness. A de-rotation brace will address the rotation, which is the driving factor in scoliosis. It will be more effective than a brace which merely works on the cobb angle.
We understand that wearing a brace can be challenging.
Our approach is built on a foundation of support and education.
We encourage open communication and are always available to answer questions and provide encouragement.
With the right support, most children and teens adapt well to wearing their brace.
They can and should continue with their normal activities, including most sports.
Working together, we can achieve the best possible outcome for your child.