Scoliosis Brace Treatment May Be Making Your Child Worse
If there ever was a time when a patient could benefit most greatly from scoliosis exercise, or non-surgical scoliosis treatment, it would undoubtedly be during the mild/moderate scoliosis stage of the condition - before the muscles & tissues of the body have been deformed by months or even years of compensating for the abnormal twisting & bending of the scoliosis spine.
Back Bracing dates back to approximately 650 AD, when Paul of Aegina suggested bandaging scoliosis patients with wooden strips. The first metal scoliosis brace was developed by Ambroise Pare in the 16th century. Today, there is a bewildering assortment of braces for scoliosis in use, ranging from the venerable and bulky Milwaukee bacl brace, to the traditional TLSO (thoraco-lumbar-sacral orthosis) back braces such as the Boston brace and the Wilmington brace. There is "part-time" scoliosis 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 scoliosis brace would be the SpineCor brace, developed at the Sainte-Justine Hospital in 1992, or (the often painful) over-correction brace Rigo Chaneau model, which is a that attempts to force the spine to grow straighter through extreme pressure, and pain.
This dizzying variety is further complicated by the fact that not every doctor prescribes the scoliosis 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 back bracing in scoliosis treatment. Some studies have shown very little difference between patients who wore the scoliosis 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 back brace constantly; yet, there are also studies on patients who wore the scoliosis 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.
FACT: Scoliosis brace treatment DOES NOT prevent or reduce the need for scoliosis surgery.
A 2007 study published in SPINE (which was a review of 18 separate studies) by Drs. Dolan and Weinstein concluded that observation only (no treatment) or scoliosis back bracing showed no clear advantage of either approach. Furthermore one can not recommend one approach over another to prevent (scoliosis) surgery. They gave the recommendation for bracing a grade "D" relative to observation only because of "troublingly inconsistent or inconclusive studies on any level."
FACT: Rigid scoliosis brace treatment may INCREASE the amount of body deformity.
These images from the "in-brace" 3-D CAT scan clearly demonstrates a dramatic increase in the rib cage rotation (which creates the rib hump) vs. the "out-of-brace" 3-D CAT scan.
New Research Suggests Scoliosis Brace Treatment May Have Negative Long- Term Effects
Excerpts from Dr. Ian Stokes 2010 SOSORT presentation on the possible effects of immobilization (AKA: scoliosis brace treatment) on spinal discs in scoliosis based off his rat tail research.
"Both vertebral and disc deformity contribute to the idiopathic scoliosis deformity, but the cobb angle measures both without distinguishing their relative magnitudes, which is approximately equal. Conversely, discs do not grow in height while adolescent deformity is progressing. It appears from a few studies that progression of scoliosis occurs initially in the discs and subsequently in the vertebrae. Nutritional compromise has been implicated premature disc degeneration on the concave (inside) side in scoliosis. Our rat tail model in which a curvature is imposed along with compression develops a 'structural' [Aka: permanent] disc deformity with tissue remodeling after 5 weeks, and we are studying the underlying mechanisms."
"The disc wedging structural changes in human scoliosis may result from reduced mobility"
"Disc deformity is a significant contributor to scoliosis, not specifically measured relative to vertebral deformity by cobb angle. Prevention of progressive disc deformity may require maintenance of mobility as well as reversal of loading asymmetry."
The developers of the Scoliscore™ genetic pre-disposition test did a comparison study of back brace for scoliosis treated patients vs. non-treated scoliosis patients and "genetically risk stratified" each group according to their Scoliscore™; which is to say they compared patients with low genetic risk to low genetic risk, and high genetic risk to high genetic risk. This allows for a more accurate "apples to apples" scoliosis treatment comparison.
According to the data displayed on the chart above, back bracing for scoliosis does not alter the natural course of the condition, halt progression, or prevent the need for scoliosis surgery.
"If bracing does not reduce the proportion of children with AIS who require surgery for cosmetic improvement of their deformity, it cannot be said to provide a meaningful advantage to the patient or the community."
~ Adolescent idiopathic scoliosis: the effect of brace treatment on the incidence of surgery. Spine 2001 Jan 1;26(1)42-7 Children's Research Center, Dublin, Ireland