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There are several recent research publications discussing the inability of a rigid brace to stop progression. In fact, rigid bracing has even been sited as having a similar effect as observation only. I would like to shed some light on rib cage biomechanics and why rigid bracing won't work and in some cases may contribute to progression. 3-D CT scans are taken to view the spine from top down or bottom up essential the same picture referred to as an axial view. This is an extremely valuable tool because it gives the doctor a 3 dimentional perspective of the scoliotic spine.

 

After researching the biomechanical characteristics of rib cage versus spine motion, primarily the effects of rotation of the entire torso on the spine and also compression of the ribcage on the spine it has become very clear that forcing pressure into the convexity of the curve to reduce the Cobb angle will increase the vertebral rotation. This means that as you push against the rib cage on the side of curve convexity the ribs will put direct pressure on the spine causing the vertebrae to rotate into the direction of force. As the brace pushes the ribcage with force decreasing the lateral flexion component Cobb's angle the force will also cause the spinous processes to rotate into the concavity creating more tension on the central nervous system via the spinal cord. Therefore the rotation must first be taken out via body positioning before force can be added to the ribcage on the side of convexity which is not possible with rigid bracing, nor with soft bracing.

 

The CT scans performed on patients while wearing the rigid brace clearly demonstrate an increase in the sharpness of rib deformity, so not only is it increasing the rib hump, but in addition it is adversely effecting the spie rotation. Now some may argue that rigid bracing worked to halt their child's scoliosis and that may be true. If the brace is placed on a minimally rotated spine it may actually have aided in stopping progression or the spine even without the brace would have not progressed via its natural course either way hard to dispute because the later is hypothetical.

 

I propose that anyone even considering a rigid brace have the rotation of the apical vertebrae evaluated in and out of brace to determine if in fact it is causing detrimental increases of spinal twisting and harm to the spinal cord. I also propose that an alternative treatment program be considered involving rehabilitation that includes  full knowledge of spine biomechanics especially when dealing with the dynamic motion of the ribcage and it's effects upon the vertebrae.