Scoliosis Bracing is one of the most effective ways to treat Scoliosis – today it’s the preferred method used by Scoliosis specialists, and increasingly it’s seen as a worthwhile methodology even by some spinal surgeons. Bracing works by gently applying pressure to the spine while the brace is being worn – this slowly guides the spine back into the correct position, correcting Scoliosis over time. A natural question which often comes up is, therefore, what happens after bracing? Will the curve return?
Scoliosis progression
Scoliosis itself is a progressive condition – this means it tends to get worse over time. In children and young adults it worsens very quickly, especially around growth spurts. Once the body reaches Skeletal maturity (which is usually a bit later than the point at which someone is legally considered an adult) the progression of Scoliosis tends to stop, or at least slow. Research suggests that the size of a Scoliotic curve a person carries into adulthood is a major factor in determining wheather their cure continues to grow. Larger curves (approximately 30 degrees or more) which are carried into adulthood tend to progress throughout life – about 1 degree per year is a commonly cited figure[1] – conversely, curves which are less than 30 degrees often don’t progress.
Scoliosis also commonly impacts older individuals – the prevalence of scoliosis increases with age, so that roughly 30% of the population over 60 have adult scoliosis, although in older people the cause is slightly different – most cases are age-related due to wear and tear on the spine, although having Scoliosis already can make this kind progress more quickly.
What we can take away from this is that the core objective of Scoliosis bracing should be to get people to skeletal maturity with a curve as small as possible, and below 30 degrees wherever viable. This gives a person the best chance of living the rest of their life with minimal or no impact from Scoliosis.
Curves after bracing
While most of the research being carried out in the Scoliosis field relates to treating curves in the first place, some studies have looked at the issue of loss of correction. One recent study aimed to evaluate the
loss of the scoliotic curve correction in patients treated with bracing during adolescence and to compare patient outcomes of under and over 30 Cobb degrees, 10 years after brace removal.
As part of the study, researchers reviewed 93 (87 female) of 200 and nine patients with adolescent idiopathic scoliosis (AIS) who were treated with the Lyon or PASB brace at a mean of 15 years (range 10–35). All patients answered a simple questionnaire (including work status, pregnancy, and pain) and underwent clinical and radiological examination.
The patients underwent a long-term follow-up at a mean age of 184.1 months (roughly 15 years) after brace removal. The pre-brace scoliotic mean curve was 32.28° (± 9.4°); after treatment, the mean was 19.35° and increased to a minimum of 22.12° in the 10 years following brace removal. However, there was no significant difference in the mean Cobb angle between the end of weaning and long-term follow-up period. The curve angle of patients who were treated with a brace from the beginning was reduced by 13° during the treatment, but the curve size lost 3° at the follow-up period.
The groups over 30° showed a pre-brace scoliotic mean curve of 41.15°; at the end of weaning, the mean curve angle was 25.85° and increased to a mean of 29.73° at follow-up; instead, the groups measuring ≤ 30° showed a pre-brace scoliotic mean curve of 25.58°; at the end of weaning, it was reduced to a mean of 14.24° and it increased to 16.38° at follow-up.
The basic conclusion was therefore that Scoliotic curves did not deteriorate beyond their original curve size after bracing in both groups at the 15-year follow-ups. Interestingly, there was also no significant difference in the mean progression of curve magnitude between the ≤ 30° and > 30° groups at the long-term follow-up, which tends not to support the traditional thinking that larger curves progress more through adulthood.
Preventing loss of correction
From the above, we can conclude that a small amount of curve increase is likely when discontinuing bracing treatment – however, It’s important to keep in mind that rather than simply weaning off of a brace, it’s possible to be more proactive about the end phases of treatment. One option, for example, is to continue with a Scoliosis specific exercise regimen – research demonstrates that doing so can help to prevent loss of correction after treatment.[2]
While we are not aware of any specific studies which have looked at this issue, one other factor to consider is a possible weakening of muscles which can take place during bracing. A brace takes much of the load off of the musculature which surrounds the spine, so that after a period of years wearing a brace a person may be less able to support themselves and maintain good posture. Studies have shown, however, that Scoliosis specific exercise can be effective in reducing muscle stiffness and loss of strength during bracing[3] suggesting again that a “proactive” end to bracing may help to reduce the risk of loss of correction even further.
[1] Weinstein SL, Ponseti IV: Curve progression in idiopathic scoliosis. J Bone Joint Surg (Am) 1983, 65:447-455.
Weinstein SL, Zavala DC, Ponseti IV: Idiopathic scoliosis: longterm follow-up and prognosis in untreated patients. J Bone Joint Surg (Am) 1981, 63:702-712.
Ascani E, Bartolozzi P, Logroscino CA, Marchetti PG, Ponte A, Savini R, Travaglini F, Binazzi R, Di Silvestre M: Natural history of untreated idiopathic scoliosis after skeletal maturity. Spine 1986, 11:784-789.
[2] Fabio Zaina et al. Specific exercises performed in the period of brace weaning can avoid loss of correction in Adolescent Idiopathic Scoliosis (AIS) patients: Winner of SOSORT’s 2008 Award for Best Clinical Paper, Scoliosis 2009, 4:8
[3] Negrini S, Aulisa L, Ferraro C, Fraschini P, Masiero S, Simonazzi P, Tedeschi C, Venturin A: Italian guidelines on rehabilitation treatment of adolescents with scoliosis or other spinal deformities. Eura Medicophys 2005, 41(2):183-201
