Scoliosis Brace Treatment Significantly Decreases Lung Function

Numerous recent studies have challenged the use of scoliosis brace treatment for adolescent idiopathic scoliosis as a nonsurgical treatment strategy to prevent curve progression mainly due to lack of empirical evidence supporting its long term effectiveness and also due to psychological problems directly attributed to scoliosis brace wear. The most common scoliosis brace utilized in the United States is the TLSO thoraco-lumbar-sacral-orthosis commonly referred to as the Boston Brace. The Boston Scoliosis Brace is primarily used for thoracic curvatures with apexes no higher than T7. Very little attention has been given to the fact that rigid braces severely restrict the mobility of the abdomen and chest wall. Studies performed by the Laboratory of Clinical Physiology Ulleval Hospital Sophies Minde Orthopaedic Hospital Oslo, Norway involving the use of the Boston Brace (TLSO) demonstrated a significant decrease in pulmonary function both at rest and during exercise while wearing the Boston Brace.

The majority of adolescents that are prescribed scoliosis brace treatment are told to wear their scoliosis brace for 23 hours daily. As we start to dissect the physiological effects we can understand why a major issue exists with compliance when wearing the Boston Brace or any other rigid brace. The amount of physical discomfort that is occurring is in most cases ignored and poorly understood. If someone were to aggressively squeeze your chest wall and then press on your abdomen and then hold it for 23 hours daily how would you feel? The amount of functional loss to the patients breathing mechanics is upsetting and potentially dangerous. The respiratory studies indicated a significant decrease in breathing capacity and also in oxygen and CO2 exchanges ratios causing an innate neurological breathing adaptation to take place in order to survive. Most studies however indicated that the breathing and pulmonary testing returned to normal once the brace was removed but you have to wonder what type of cellular damage or other health implications may occur while in the scoliosis brace.

Understanding human physiology, however complex, may be simplified to some general facts. Breathing isn't just affecting oxygen intake and gas exchange it has a major effect on other aspects of human health. Breathing has a significant impact on hormone regulation including estrogen, progesterone, growth hormone, and thyroid hormones. In addition breathing has a direct affect on muscle and fat composition as well as cognitive performance. Regardless if the breathing capacity returns to normal after wearing the Boston Scoliosis Brace, we may instead want to discuss what impact it may have on a child's health while wearing it. There are currently no known studies addressing this issue but it would certainly be interesting to see how much of an impact restricting breathing capacity for 23 hours a day might have on a growing body.

The Boston Scoliosis Brace mechanically produces pressure on both the chest wall and the abdomen allowing for little compensation within the breathing mechanism. The studies that were performed on children wearing the Boston Brace demonstrated a 30% decrease in VC (vital capacity) and a 45% decrease in ERV (expiratory reserve volume) the same type of decreases found in long term smokers. Symptoms related to respiratory distress may include headaches, anxiety, sleep disturbance, nightmares and cognitive dysfunction.

It is unfortunate that such an invasive treatment is often utilized in hopes of preventing scoliosis progression with little consideration of how it will affect the child during and after the treatment. Such narrow minded thinking with a sole focus on a Cobb angle measurement seems to stifle all other rational thought as to side effects from scoliosis bracing. With recent evidence discovered by the genetic research team at Axial BioTech suggesting that spinal bracing does not alter the natural course of scoliosis, empirical data demonstrating the significant pulmonary stress while wearing the Boston Brace combined with the known psychological problems associated with scoliosis brace wear, parents and their doctor must closely consider risks versus benefits when considering use of the Boston Scoliosis Brace.

Don't let a lifetime be defined by idiopathic scoliosis

Now that genetic pre-disposition testing for scoliosis progression risk is available; An Early Stage Intervention Program has also been developed to provide scoliosis patients a non-bracing, non-surgical treatment option that allows them to take immediate action in the prevention of the next stage of the standard treatment process (scoliosis bracing or scoliosis fusion surgery).

While it is not the intention of CLEAR Institute to condemn the efforts of sincere and caring medical professionals who have dedicated their lives to helping individuals with scoliosis. We would, however, like to add to the current list of options; to educate those who are personally involved with scoliosis about what the research says; and, to empower these individuals to make their own decision regarding their own spine, and their own life.

The three medically-sanctioned methods of scoliosis treatment - observation, bracing, and surgery - have been around for decades. A great deal of research has been done on the risks & benefits of each option. However, the general conclusion of this research suggests that a new paradigm is desperately needed as there are many conflicts and inadequacies present in the current model.

Observation Only or the “watch & wait” stage

Once an individual has been diagnosed with scoliosis, no treatment is initially prescribed, and no action is immediately taken, until the Cobb angle has progressed to 25 degrees (which is an arbitrary figure. There is no clinical significance to this number). At this point, bracing is typically prescribed. This period, which is termed "watch & wait," consists only of regular visits to an orthopedic surgeon, where full-spine x-rays are taken consistently to gauge the progress of the patient's condition.

Scoliosis brace treatment (Generally recommended for curvatures 25 degrees and larger)
If there ever was a time when a patient could benefit most greatly from chiropractic, therapeutic exercise, or non-surgical intervention, it would undoubtedly be during the mild stages of the disease - before the muscles & tissues of the body have been deformed by months or even years of compensating for the abnormal twisting & bending of the spine.

Scoliosis bracing dates back to approximately 650 AD, when Paul of Aegina suggested bandaging scoliosis patients with wooden strips. The first metal brace was developed by Ambroise Pare in the 16th century. Today, there is a bewildering assortment of braces in use, ranging from the venerable and bulky Milwaukee brace, to the traditional TLSO (thoraco-lumbar-sacral orthosis) braces such as the Boston and the Wilmington brace. There are "part-time" braces, designed to be worn at night: the Providence brace, and the Charleston brace. There are also "dynamic corrective braces" which may use soft, elastic materials and claim to be able to do more than simply stabilize the progression of scoliosis. An example of a dynamic corrective brace would be the SpineCor brace, developed at the Sainte-Justine Hospital in 1992, or the Copes brace, developed by Arthur Copes to be used in conjunction with his STARS (Scoliosis Treatment Advanced Recovery System) rehabilitation protocol.

This dizzying variety is further complicated by the fact that not every doctor prescribes the braces to be used in the same manner, and not every patient may follow their doctor's recommendations to the same extent. As a result, research is often conflicting (to say the least) in regard to the true effectiveness of bracing in scoliosis treatment. Some studies have shown very little difference between patients who wore the brace for the prescribed time, and those who wore it barely, if at all. Others have demonstrated patients who have been successfully stabilized for years by wearing a bracing constantly; yet, there are also studies on patients who wore the brace for 23 hours out of every day, seven days a week, and continued to worsen. In every case, all corrective benefit is lost very quickly once the patient stops wearing the brace, and the general consensus is that bracing may prove helpful for some, but not for others.

Scoliosis surgery (Generally recommended of curvatures 40 degrees and larger)
Those patients for whom bracing fails to prevent the progression of their scoliosis are left with only one option: surgery. Those who are confronted with this choice may be told that having a metal rod fused to their spine will not impair their daily activities, and will reduce the rib arch & improve their cosmetic appearance. However, research has consistently shown that surgery - which primarily focuses upon the sideways bending, and does little to address the rotation of the spine (and hence the rib protrusion) - will actually cause the rib arch to worsen (Chen 2002, Goldberg 2003, Hill 2002, Pratt 2001, Weatherly 1980, Wood 1991, Wood 1997).

Scoliosis surgery, like most highly-invasive procedures, carries with it the ever-present risk of death. Although mortality rates of less than one percent are claimed, no surgeon can completely eliminate this possibility. There is also the danger of neurological damage, resulting in the loss of sensation or motor function to the arms & legs (paraplegia or quadraplegia). This has become a greater concern in recent years, as surgeons strive for greater corrections in their patients, and place more stress upon the nerves running through the spinal column.

The rate of hardware failure is virtually 100% over the course of a normal lifetime. It may occur immediately after the surgery or several years later, but one or more components of the hardware placed inside the body is highly likely to fail or break. The author of one study stated, "One would expect that if the patient lives long enough, rod breakage will be a virtual certainty". Another study found that amongst seventy-four patients who underwent the surgery, pseudoarthrosis (failed fusion) occurred in 27% of patients within a few years after the procedure.

The truth of the matter is that scoliosis is an abnormality of the spine which involves much more than merely a sideways curve. Yet the "effectiveness" of surgery is measured only by the degree to which it can reduce the lateral deviation through the application of brute force, and a fused spine is every bit as abnormal and dysfunctional as a scoliotic spine.

We can alter the natural course of this disease by identifying which patients are at the highest risk for severe progression via genetic testing (Scoliscore) and by implementing an aggressive, non-invasive Early Stage Scoliosis Intervention program that re-trains the brains involuntary postural controls centers before the spinal curvature reaches the 30 degree "buckling" point