Types of Scoliosis Braces: TLSO, SpineCor, Charleston & Providence

Last updated on August 18th, 2021 at 12:11 am

Doctors prescribe scoliosis braces for one in five adolescents who have the condition. As a result, an estimated 30,000 children are wedged into braces each year. But to what end?

Despite the fact that scoliosis bracing has existed for centuries and has been considered the standard surgery prevention tactic since the modern brace was invented in the 1940s, there is little evidence to support its effectiveness.

Although a 2013 study concluded that bracing was more likely to prevent the need for surgery than the alternative “watch-and-wait” method, it also found strong evidence that many scoliosis braces are prescribed unnecessarily. Nearly half of all patients in the watch-and-wait group never progressed to the point of needing surgery even without a brace, and the same is true for more than 40 percent of the kids who were prescribed braces but rarely wore them.

To further complicate the picture, many different types of scoliosis braces have evolved over the past several decades, and each type works differently. There is a lot of conflicting data about their success rates, which makes it difficult to get a clear picture of how they compare and the health risks they pose.

Nevertheless, here is a rundown of some of the most well-known scoliosis brace types:

TLSO Scoliosis Brace

The TLSO brace is the most commonly worn scoliosis brace in the United States. In the study mentioned above, 68 percent of brace-wearing patients used one. It is typically made of rigid polyethylene plastic and worn around the rib cage, lower back, and hips to apply pressure at three points along the spine.

There are a variety of TLSO braces. The most popular of these bracing systems, the Boston brace, originated in 1972 at the Boston Children’s Hospital. Developed by Dr. John Hall and William Miller, it was the first scoliosis brace to eliminate the need for a metal superstructure, making it less noticeable beneath clothing. (Compliance has always been a challenge in scoliosis treatment, and doctors hoped the added comfort would entice patients to wear their braces more often.)

Despite its popularity, the Boston scoliosis brace can create adverse health problems for kids. When the rigid plastic squeezes the chest wall for 18-23 hours each day, children suffer significant losses in breathing capacity and other pulmonary functions. In one study, wearing the TLSO brace caused a 30 percent drop in vital capacity.

SpineCor Scoliosis Brace

To encourage patient compliance with correctly and continuously wearing scoliosis braces, some doctors have resorted to flexible bracing systems that allow partial movement and can adjust to accommodate a child’s growing body.

The most widely recognized “flexible” brace, the SpineCor brace, is based on a theory that scoliosis stems from three main factors: postural disorganization, muscular dysfunction, and unsynchronized spinal growth. In 1998, pediatric surgeons from Sainte-Justine Hospital in Montreal hypothesized that their dynamic brace could prevent and even improve spinal abnormalities by influencing these factors through controlled movement.

It is not an entirely new concept. Soft braces were used to treat scoliosis as early as 1876, but became obsolete with the invention of the rigid brace just 26 years later. Today’s versions are less likely to infringe on a patient’s quality of life than their hard plastic counterparts, which makes it easier to tolerate wearing them for 20 hours a day.

Quality of life may come with a tradeoff, however. Conflicting data makes it difficult to assess the success of the SpineCor brace, but past studies suggest it is even less effective than a hard brace. More recently, researchers using standardized criteria developed by the Scoliosis Research Society found no significant difference in success rates between the SpineCor and TLSO braces. Since even dynamic braces allow children’s developing muscles to atrophy — causing the curve to rapidly worsen once the brace is removed — the risk may not be worth the reward.

Charleston Bending Brace

Nighttime braces offer another solution to patient compliance with consistently wearing scoliosis braces. Some orthopedic surgeons have modified traditional brace designs to apply stronger corrective force, reducing the wear time to just 8-10 hours — the length of a good night’s sleep.

The Charleston bending brace became the first side-bending nighttime treatment in 1979. A collaboration between Dr. Frederick Reed of South Carolina and his colleague, orthotist Ralph Hooper, the Charleston bending brace fixes the patient in an over-corrected position to stretch the spine farther than a traditional TLSO brace. By wearing it only at night, they reasoned, patients could avoid the social anxiety and negative self-image issues that often accompany scoliosis bracing (especially in adolescent girls).

Despite the reduced wearing time, the Charleston brace still suffers from compliance issues. Patients find the overstretching uncomfortable when they are trying to sleep, and some report morning soreness that can last up to three hours. In some patients, the aggressive stretching can actually worsen the spine’s secondary curves. Most doctors consider this brace effective only in specific and limited situations.

Providence Scoliosis Brace

The latest evolution of the nighttime brace aims to achieve maximum curve correction with minimal discomfort. Instead of bending the spine, the Providence brace applies direct, opposing forces to straighten abnormal curves.

In 1992, creators Charles d’Amato and Barry McCoy of the Children’s Hospital of Rhode Island in Providence stumbled upon the design for their brace while developing a preoperative spinal X-ray method for patients about to undergo scoliosis surgery. Although it is less effective than the Boston brace at treating large curves, researchers do recommend it for less pronounced curves, and some doctors prescribe a combination of both braces.

There is no reliable data on whether the improved comfort of the Providence scoliosis brace makes patients more likely to wear it, partly because they sometimes accidentally remove it in their sleep. One common complaint about the Providence scoliosis brace is that the tilt of the shoulders and rotation of the torso make standing and walking difficult when patients need to get up at night.

Rethinking Scoliosis Bracing

For all their differences, these various types of scoliosis braces share a critical commonality: They all attempt to correct a neurological problem with physical treatment. Even when successful, most braces merely tackle the symptoms without addressing the underlying problem, which is that the brain doesn’t recognize that the spine is out of alignment, so the body’s posture-correcting mechanism doesn’t kick in.

Instead of forcing correction, building new muscle memory helps the spine unwind naturally by reducing asymmetrical muscle firing. That is the guiding principle behind the ScoliSMART™ Activity Suit, an exercise program used in combination with outpatient care to hold the spine straighter without causing pressure or pain. The suit uses active resistance and the patient’s natural locomotion pattern to return the spine to a more neutral position.

This latest innovation in scoliosis treatment has been a long time coming. For more than 400 years, braces have been the predominant method for halting the progression of spinal curvature, despite their uninspiring success rates, high social costs, and significant health risks. The more we learn about how this condition works, the more obvious it becomes that it is time to approach scoliosis from a new angle.

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