Category: Blog

COVID-19 and Scoliosis – What you need to know

As we all know, COVID-19 seems, for the most part, seems to have a more significant impact on those with pre-existing health conditions. Sadly, many fit, healthy younger people have died from the virus, but it’s clear that those with health complications or who are simply a little older are disproportionately represented in the death statistics.

We have had questions from many clients, and indeed non-clients, wondering about how COVID-19 impacts those with scoliosis. While it’s important to stress that you should consult with your GP on your individual case, here are our best answers to some of your common questions at this stage.

 

Does scoliosis increase my risk to COVID-19?

At present, the UK government has defined two groups of people who are expected to be extremely vulnerable, and moderately vulnerable to COVID-19. At the present time, there is no evidence to suggest that Scoliosis itself is a factor in COVID-19 risk, although there are some areas where we would advise our clients to be cautious.

These lists are subject to change as we learn more about the virus, however at this time, the conditions listed are:

 

People at high risk (clinically extremely vulnerable)

People at high risk from coronavirus include people who:

  • have had an organ transplant
  • are having chemotherapy or antibody treatment for cancer, including immunotherapy
  • are having an intense course of radiotherapy (radical radiotherapy) for lung cancer
  • are having targeted cancer treatments that can affect the immune system (such as protein kinase inhibitors or PARP inhibitors)
  • have blood or bone marrow cancer (such as leukaemia, lymphoma or myeloma)
  • have had a bone marrow or stem cell transplant in the past 6 months, or are still taking immunosuppressant medicine
  • have been told by a doctor they have a severe lung condition (such as cystic fibrosis, severe asthma or severe COPD)
  • have a condition that means they have a very high risk of getting infections (such as SCID or sickle cell)
  • are taking medicine that makes them much more likely to get infections (such as high doses of steroids or immunosuppressant medicine)
  • have a serious heart condition and are pregnant

 

People at moderate risk (clinically vulnerable)

People at moderate risk from coronavirus include people who:

  • are 70 or older
  • have a lung condition that’s not severe (such as asthma, COPD, emphysema or bronchitis)
  • have heart disease (such as heart failure)
  • have diabetes
  • have chronic kidney disease
  • have liver disease (such as hepatitis)
  • have a condition affecting the brain or nerves (such as Parkinson’s disease, motor neurone disease, multiple sclerosis or cerebral palsy)
  • have a condition that means they have a high risk of getting infections
  • are taking medicine that can affect the immune system (such as low doses of steroids)
  • are very obese (a BMI of 40 or above)
  • are pregnant – see advice about pregnancy and coronavirus

 

While scoliosis is not specifically listed here, there are several conclusions and cases we can take into account.

Firstly, severe cases of scoliosis can restrict breathing and reduce respiratory function – it has been shown that even under normal circumstances, those with scoliosis tend to have the lower functional capacity in this regard (that is to say, the ability to respire effectively). Many individuals with scoliosis do not experience these difficulties, however, it may be prudent to practice very strict social distancing out of caution. If you are aware that you have breathing difficulties as a result of scoliosis, we would suggest that you contact your GP for further advice, but consider yourself at higher risk.

Secondly, many scoliosis patients are older individuals suffering from de-novo scoliosis. De-novo scoliosis is very common in the population over 70 and again, may serve to limit mobility and perhaps respiration. In line with government guidelines, we recommend that this group take extra care.

Thirdly, while scoliosis is not generally considered a major issue as far as pregnancy is concerned, we suggest you inform your care team immediately if they do not already know you have scoliosis. It is important, for example, when placing an epidural, for your clinical care team to be aware that you have scoliosis. Because of the additional factors which scoliosis can bring to birth specifically, we recommend that you plan to have your child in hospital rather than considering a home birth or an alternative due to coronavirus.

 

Lockdown and scoliosis – what should I do?

Lockdown, while unpleasant has thus far been the most effective method available to control coronavirus. It’s clear that by reducing social contact we can slow the spread of the virus – however, it’s also becoming clear that many are now not persuing medical issues and treatment which they otherwise would. Initially, it was not possible to continue with many treatments, however, most clinics are now running as normal, with safety measures in place. We recommend the following while in lockdown:

  • Try to stay active as you normally would – if you have prescribed exercises, ensure that you do them each day as normal.
  • If you are bracing, continue with your wear time as usual. Do not be tempted to alter this yourself without consultation.
  • If you are due a brace or exercise review, the clinic is now open for you, if you are able to attend.
  • If you cannot attend the clinic in person, we can arrange a telehealth appointment for you as an alternative. We would suggest that a telehealth appointment is preferable to travel on public transport at this time, although if you can attend the clinic using private transportation this is better still.

 

I think I may have scoliosis, what should I do?

It’s critical that new scoliosis cases continue to be treated as quickly as possible, notwithstanding COVID-19. In Adolescent cases, in particular, even a few weeks can make a significant difference to the path of treatment as well as the potential outcome.

The UK Scoliosis clinic has re-opened for current patients and new or suspected worsening scoliosis cases. Social distancing can be maintained at all times at our clinic and special measures have been put in place to protect you. The total exposure to others required for a scoliosis consultation and even the instigation of a treatment plan is very low.

What is scoliosis anyway?

As you may – or may well, or well not ­– be aware, June is Scoliosis awareness month. Since so many of us are working from home, or simply having to take a break from normal life at the moment, you may well have noticed some talk about this online, so, what is Scoliosis, and why should be you be aware of it?

 

What is Scoliosis?

Simply put, scoliosis is a spinal disorder which causes the spine itself to be curved from side to side. A normal spine does indeed have a forwards and backwards curvature, so that viewed from the side it looks like an “S” shape – but in scoliosis, the spine also has a side to side curvature, so that viewed from the front or the back, it has an “S” or “C” shape. In fact, scoliosis is more complicated than this – there’s typically also a rotation of the vertebra (the spinal bones), but the general shape is what you might be able to notice in someone’s posture.

 

Can I see Scoliosis?

Scoliosis is sometimes possible to see, usually in more severe cases. In some individuals with very low body fat, it may be possible to notice the curvature of the spine – however, most common signs (like uneven shoulders and hips, or a rib hump when bending forward or one shoulder blade seeming to stick out more than another) tend to be the only noticeable change. It’s true that the worse a scoliosis case is, the more visible it will tend to be – but scoliosis can remain almost invisible for a long time before reaching this point.

Like all conditions, scoliosis is much easier to treat if it’s spotted early –  this is where scoliosis screening comes in. Scoliosis screening is a fast, painless and simple procedure which you can even try at home. In fact, many countries include scoliosis screenings as part of their public health measures, however, this isn’t the case in the UK.

 

Who can get Scoliosis?

Anyone can get scoliosis – on average, about 3% of children will develop scoliosis, whereas some forms of scoliosis, common amongst the older population can affect up to 30%.[1]

There are many different sub-types of scoliosis, but for ease of explanation we typically divide them into two groups – these are adult, and childhood scoliosis.

Adult scoliosis is caused either by the degeneration of the spinal bones, ligaments & discs with age or as a result of childhood scoliosis which was not treated. Childhood scoliosis (affecting infants through to young adults) is more of a mystery – right now the exact cause for about 80% of cases is unknown. This is termed “Idiopathic” scoliosis. The remaining 20% of cases are typically caused by congenital or genetic conditions, spinal malformations, underlying neuromuscular conditions, metabolic conditions or trauma.

Idiopathic scoliosis in children is typically classified according to the age that it is diagnosed. It is most common in adolescents (over 10 years) but also occurs in infants (under 3 years) and juvenile’s (3-10 years).

Approximately 3-4% of children are affected by scoliosis, that’s about one in each class at school. In adults over the age of 50, this figure increases to 30-40%.

The earlier scoliosis is detected, the more effective a treatment and management plan will be. This helps reduce the risk of progression and the potential need for surgery. If scoliosis specific exercise and/or bracing are used early enough in the development of scoliosis, curve progression can be stopped, and surgery avoided. In some cases, near-complete correction of the curve is possible.

 

How do I screen for scoliosis?

Screening for scoliosis is easy to do and takes less than 5 minutes – remember that early detection is the most important factor, so screen regularly and if you have concerns, get in touch with a scoliosis professional.

 

 

[1] Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender‘

Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

Telehealth consultations – Now available!

The COVID-19 Crisis sweeping the world is making everyday life hard for all of us. While there are many issues which can be put “on the back burner” a scoliosis consultation should not be one of these. For patients at a high risk of progression – for example, those between 10 and 18 – scoliosis can evolve very quickly, which means a swift consultation is a must.

Effective immediately, Dr Paul Irvine, Dr of Chiropractic and founder of the clinic, will be offering Scoliosis consultations online in a highly secure, private environment. While a teleconsultation is not a replacement for an in-person appointment, it represents an excellent way to get an initial diagnosis and further information about next steps.

We will be posting more information about this option shortly – in the meantime, if you are urgently seeking an appointment please get in touch via our normal phone number and we will arrange an appointment with you, and answer any questions you have.

Scoliosis and Kyphosis, what’s the difference?

Given our name being the UK Scoliosis clinic you would expect or focus to be on the non-surgical treatment of scoliosis, however, we also work with many patients suffering from another common spinal condition – Kyphosis. But what’s the difference between Scoliosis and Kyphosis?

 

Kyphosis

Kyphosis is the condition which causes what’s sometimes called a “hunchback”, people with this condition tend to hunch forward, and, as you may have already realised, it’s getting far more common today than ever before.

But isn’t the spine supposed to bend forward slightly? – yes, it certainly is, however, when this forward bend becomes too pronounced it can become an issue. As a general guide,  it’s normal to have a mid-back kyphosis (backward c-shape curve) at approximately 40 degrees. Above this, unpleasant symptoms may result.

Typically, patients complain of aching and stiffness in their mid-back and lower back. It worsens when weight-bearing, especially when doing activities that require repeated bending such as gardening. Often, teenagers are noticeably hunched from spending hours on their phones, tablet’s or PC’s – a trend which often worsens into adulthood. Most age groups are at risk of Kyphosis, although there is probably a stronger link with lifestyle than with age per se.

 

Causes of Kyphosis

Like scoliosis, there can be different underlying causes of kyphosis, but unlike scoliosis, we understand these potential causes well. There are 4 main underlying issues which can lead to Kyphosis, these are:

 

Postural Kyphosis – is the most common form and the one which is increasing faster than ever before. Postural kyphosis is noticeable, in that it will appear when standing and sitting and disappear when laying face down. Postural kyphosis isn’t a structural problem caused by an abnormal shape of the vertebra that make up the spine, but rather by the supporting muscles and tissues. Over time, as we remain in a slouched position (such as sitting at a desk all day or hunched forward gaming for hours on end) certain muscles become too tight, others become weak and loose, leaving us with a “hunchback” look. Postural kyphosis, disappears when laying face down as the spine is able to return to its normal position, without the need the need for the surrounding muscles muscles to work and support the spine against the force of gravity.

 

Scheuermanns kyphosis

Scheuermann’s disease – is far less common, and results in an increased kyphosis throughout the teenage years whilst growth is occurring. It is a growth plate disorder in the vertebrae themselves, which causes them to become more wedged and compressed at the front, hence the increase in kyphosis. This will result in structural deformity as the bone formation is altered. Scheuermann’s cannot be “cured” or reversed, however, the right treatment at the right time, can help to significantly reduce the progression of the deformity. Bracing in the right cases has been shown to be a very effective treatment when combined with specific posture exercises.

 

 

 

 

 

Osteoporatic fracture, and kyphosis

Osteoporosis of the spine – is a common cause in older individuals – here, the fundamental cause is vertebrae undergoing compression fractures due to a loss of bone strength. Osteoporosis of the spine can cause a large increase in the kyphosis in people over 60. It will often continue to progress with age, thus it is vital that patients keep their posture upright and keep their bones strong for as long as possible. While again, this condition is not “curable” the right management can make a huge difference to the quality of life.

 

 

 

 

 

 Spinal malformations & birth defects – account for the majority of the remaining Kyphosis cases – there are a number of conditions which can cause the vertebra to not develop properly. Depending on the underlying condition and the severity, it may need surgical intervention.

 

Treatment Of Kyphosis

In most cases of Kyphosis, the condition can be treated effectively with specific postural correction exercises & stretches, postural traction and kypho-bracing when necessary. Advanced manual approaches such as Chiropractic Biophysics can be highly effective in resolving Kyphosis cases. Beyond initial treatment, the same approach can be used to manage and reduce the severity of symptoms, often so that the impact on daily life is very little. Only in very severe cases is surgery typically required, and this is usually due to the risk of progression and further complications. Many cases of postural kyphosis can be improved or resolved.

The pictures below show the correction in an adult male with hyper-kyphosis, through the Chiropractic Biophysics technique. The pictures are approximately 1 year apart.

Scheuermann’s disease, and cases related to osteoporosis in particular, can often benefit from part-time bracing with a specialised Kyphosis brace, such as Kyphobrace – in these cases, a “cure” is not possible, but with proper management, it is entirely possible to live a normal and healthy life with Kyphosis.

In senior’s with kyphosis, caused by underlying osteoporosis, further compression fractures become more likely as the spine becomes progressively more hunched. Hence, treatment & exercise programs need to be gentle and designed to help keep patients more upright, improve balance to resist falls, and include nutritional support to help maintain bone strength. Gentle supportive bracing in senior’s can also be effective in helping them stay upright when whey are standing and walking.

 

 

Scoliosis

Whereas Kyphosis causes “forward hunching” posture, related to an excessive forwards bend in the spine, scoliosis causes a side to side curvature of the spine resulting in a distinctive scoliosis profile.

Unlike Kyphosis, Scoliosis tends more often to be a serious condition which, in most cases, progresses (sometimes rapidly) without proper treatment. While Scoliosis can cause pain, it does not always, and in many cases it is only detected through screening or is noticed by friends of family members during a trip to the beach or when changing clothes. Whereas Kyphosis is quite easy to spot. Scoliosis can progress to a significant degree without any obvious signs, so screening is a very good idea to enable early detection.

 

Causes of Scoliosis

Whereas the causes of Kyphosis are well understood, and (with a bit of planning) you can reduce your risk through targeted exercise and fitness approaches, most cases of scoliosis have no known cause – in a large number of cases, the condition is described as ”idiopathic” – literally meaning “without known cause”.  The underlying pathologies are therefore:

 

Idiopathic scoliosis – Idiopathic scoliosis is most commonly found in younger teenagers, with the most at-risk group thought to be between the ages of roughly 11 and 16. Girls are affected more often than boys, but boys can and do develop scoliosis.  While the cause is not currently known, research suggests that genetics may play an important role. It’s also believed that participation in some activities such as ballet or gymnastics, in which there is a contortion of the spine, may hasten or promote the development of scoliosis.

 

Degenerative Scoliosis – Degenerative scoliosis is a condition typically seen in people over the age of 60. In this case, we do know the cause – degenerative or “de novo” scoliosis is simply caused by wear and tear as we age, involving changing in the shape of the vertebrae and weakening of the spinal ligaments and muscles enabling the vertebrae to twist and turn.

 

Scoliosis from other causes – Other, less common causes of scoliosis include congenital deformities and problems with the formation of the spine such as hemi-vertebra or butterfly vertebra, and are usually present from birth. Other cases may be caused by underlying neurological and syndromic conditions that may or may not have already been diagnosed.

 

Treatment for scoliosis

Scoliosis in older individuals (de novo scoliosis) cannot be “cured”, in the same way as kyphosis in older individuals cannot be “cured” – however, similar approaches can be used to significantly reduce the impact of scoliosis on one’s life, and in some instances, it is also possible to reduce the scoliotic curve itself. Scoliosis bracing can be highly effective as a means to achieve this and has also been shown to reduce pain where it exists.

Scoliosis in younger individuals is almost invariably a case of idiopathic scoliosis – the treatment for this depends on the severity of curve at time of diagnosis, but in all cases, the objective is to straighten the spine as much as possible. In cases which are caught very early, when the curve is still small, scoliosis can sometimes be corrected using scoliosis specific exercises – a regime of scientifically based movements and stretches designed to counteract the scoliotic curve. In very young patients (who are not able to perform scoliosis specific exercise) or in larger curves, scoliosis bracing is the preferred method of treatment. While bracing results vary according to the brace type that is used, today a very high number of cases treated with corrective bracing achieve a reduction of the curve down to a “normal” scoliosis value.

 

Is it Scoliosis, or Kyphosis?

If you’re unsure about an unusual posture or spinal issue you have noticed, an excellent place to start is a professional consultation at the UK Scoliosis Clinic, just get in touch!

5 scoliosis facts that may shock you!

If you’ve been reading this blog for a while, or if you have an interest in scoliosis, you will certainly have noticed some themes which come up again and again. Even a quick browse through the recent research in the field, demonstrates that the main areas of interest are fairly constant – adolescent idiopathic scoliosis, the genetic links for scoliosis and the most effective methods for reducing cobb angle come up more often than not. There’s more to scoliosis treatment than just these factors however – so this week, we look at some lesser-known but potentially surprising scoliosis facts.

 

Surprising scoliosis fact number 1

The group most at risk from scoliosis is older adults.

Because of the risk of progression, and the potential consequences if treatment is not forthcoming, much research, advertising and awareness campaigning in the scoliosis field concentrates on adolescent idiopathic scoliosis – next in line is probably juvenile scoliosis. The fact is, only about        2-3% of the population in these groups will develop scoliosis. That’s still a very large number of cases, all with a significant risk of progression, but when you crunch the numbers, its clear that older people are, in fact, the most likely to suffer from scoliosis – the risk is nearly 10 times higher!

Research indicates that approximately 30% of those over 60 suffer from scoliosis[1] – the majority of cases are termed “de-novo” which is a scoliosis that develops due to spinal degeneration and can respond well to treatment.

 

Surprising scoliosis fact number 2

Scoliosis is sometimes more common in males 

It’s true that 75% of adolescent idiopathic scoliosis cases are females, and since this gets the lions share of attention in the field, it’s little surprise that most screening campaigns and tools are targeted at young girls. That being said, in some instances scoliosis is actually more common in boys. Specifically, this is the case in cases of infantile scoliosis. Infantile scoliosis is the least common of all forms of idiopathic scoliosis and comprises only about 1% of all idiopathic scoliosis in children. However, about 60% of patients in this group are boys. Infantile scoliosis can sometimes resolve spontaneously, but presents the highest possible risk for progression, so should be monitored and treated urgently.

 

Surprising scoliosis fact Number 3

Which is better, bracing or exercise? …. Actually, it’s both!

When it comes to treatment methodologies, it’s usually a case of picking the best approach and sticking with it. As it concerns scoliosis treatment, a multiple studies have confirmed that when bracing and exercise approaches are combined the results are greater than the sum of the parts. Curve correction with a dual approach is superior to either approach alone.[2]  What’s more, it seems that using exercise approaches before and after bracing can speed correction, and then prevent loss of correction after bracing.[3]

 

Surprising scoliosis fact Number 4

Your GP knows a lot less about scoliosis treatment than you might hope.

This point isn’t about criticising GP’s – they do a fantastic job, but there’s only so much any one person can know, and as it goes, scoliosis is fairly low down the list of major concerns for the general population. The situation is especially difficult in the UK, since the National Health Service (NHS) is (understandably) not in the business of recommending private companies, and the best bracing technologies on the market today are only available privately. It’s for this reason, that you must seek a specialist scoliosis consultation whenever possible – the braces on offer through the NHS are still mainly “passive” options, which don’t correct scoliosis, just try to stop it progressing.

 

Surprising scoliosis fact number 5

Active bracing is often the most cost-effective option.

Active scoliosis braces, like ScoliBrace, are advanced medical devices and aren’t cheap – and while no one would claim that the cost of a scoliosis bracing treatment is insignificant, in many cases it can be substantially less financially impactful than many other options.

Lets briefly consider the main treatment methodologies available:

Surgery – Through the NHS in the UK, surgery for scoliosis is of course free. So naturally the issue here isn’t a financial one, but rather the cost of surgery is often in terms of complications after the event – or with the disruption that it can cause to a young persons’ life. The UK Scoliosis Clinic isn’t anti-surgery – on the contrary, we know that spinal surgeons can do fantastic work for patients who have no other option – we do, however, believe that surgery should be the last resort since for many, recovery is long and complicated. While it won’t be the case for everyone, recent meta-analyses of published research have suggested that the complication rate could be as high as 89%.[4]

Exercise – Exercise-based treatment plans are only supported by research  for small curves with a low risk of progression and while exercise might initially seem cheaper than bracing, this is only true if the treatment is appropriate. In young growing spines, the risk of scoliosis progressing in moderate to large curves is high, thus a curve must be constantly straightened via a brace rather than through the intermittent use of scoliosis specific exercise. In cases where a brace has been required and only scoliosis specific exercise used, curves will often progress and surgical correction will be required.

Other forms of bracing – Regular readers will know that Scoliosis braces are not created equal. Passive models, which don’t correct scoliosis but attempt to hold the curve in its current position, do absolutely nothing to “treat” the condition.  Other braces on the market, while still active in nature, unlike Scolibrace are often not adjustable – meaning that their corrective capacity is limited, thus a new brace is frequently required as the curve changes. This means that in many cases, an advanced adjustable brace, like ScoliBrace will be cheaper in the long term.

 

 

 

[1] Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender
Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky R, Spine 2011 Apr 20;36(9):731-6.

The prevalence and radiological findings in 1347 elderly patients with scoliosis
Hong JY, Suh SW, Modi HN, Hur CY, Song HR, Park JH.,  Journal of bone and joint surgery 2010 Jul;92(7):980-3

 

[2]The effectiveness of combined bracing and exercise in adolescent idiopathic scoliosis based on SRS and SOSORT criteira: a prospective study
Negrini S, Donzelli S, Lusini M, Minnella S and Zaina F 2014, BMC Musculoskelet Disord. 2014; 15: 263, Published online 2014 Aug 6. doi:  10.1186/1471-2474-15-263

‘Adult scoliosis treatment combing brace and exercises
Papadopolous D 2013, Scoliosis 20138(Suppl 2):O8, DOI: 10.1186/1748-7161-8-S2-O8

 

[3] Negrini S, Negrini A, Romano M, Verzini N, Parzini S: A controlled prospective study on the efficacy of SEAS.02 exercises in preparation to bracing for idiopathic scoliosis. Stud Health Technol Inform 2006, 123:519-522.

 

[4] Hans-Rudolf Weiss and Deborah Goodall, Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature, Scoliosis, 2008, 3:

How to choose a scoliosis brace – questions to ask your practitioner

Regular readers of this blog will know that at the UK Scoliosis clinic, we believe that scoliosis bracing is the best approach to reducing cobb angle in the majority of scoliosis cases, and indeed, it is becoming clear from larger-scale studies that this is the case. [1]

It’s certainly true that some smaller degree curves can be effectively treated with exercise approaches alone, however even these cases treatment with a brace will often be faster, and much easier in terms of effectiveness and compliance with younger patients.

In many instances then, parents of patients or patients may find themselves interested in the idea of bracing, but unsure about which type of brace will be the most appropriate. This week, let’s look at the factors you may want to consider when choosing a brace, and questions you may want to ask your scoliosis bracing practitioner.

 

 

1 – Active, or passive?

Once upon a time, the only kinds of scoliosis brace available were what are now known as “passive” braces – these include models such as the “Boston brace”. Passive braces are not really intended as a treatment for scoliosis, instead as a method to slow its progression. Passive braces work by holding the spine in its current, scoliotic position – this can slow and perhaps stop the progression of the condition but will do nothing to reverse it, and therefore nothing to alleviate the symptoms.

Passive braces are still offered by some clinics and are sometimes provided via the NHS – we would strongly recommend that you avoid passive braces since in the long run they will not improve the condition.

The below image shows a adolescent with idiopathic scoliosis, with a right thoracic curve measuring 49.50 degrees out of brace, and in the second X-ray (with a passive brace on)  shows the curve as almost the same, as the goal of a passive brace is too just hold the current spinal position not straighten the spine.

Active braces, such as our recommended model, the ScoliBrace, are the opposite – over time they are designed to gently guide the spine back into the correct position so that the longer the user wears the brace the greater their spine correction will be.

The below image shows a right thoracic curve similar to that of the first patient – The curve measured 41 degrees – however, this time when the In-brace x-ray was taken,  the curve reduced to 13 degrees.

 

2- Flexibility

Most modern scoliosis braces are designed using a CAD/CAM process and are therefore perfectly fitted for their users – this makes the majority of models low profile, but low profile braces are not necessarily also flexible braces. Braces such as Scolibrace are designed to be minimally restrictive when being worn and even allow the user to participate in sporting activities while wearing the brace. This may be more or less of a factor depending upon your lifestyle, but it worth keeping in mind.

 

3 – Adjustability

A big factor differentiating the cost of modern braces is their durability for use over the course of scoliosis treatment. Some cheaper scoliosis braces are manufactured to fit your body at a specific time and for a specific degree of correction only. Once you have either outgrown the brace, or you have reached the maximum degree of correction which the brace can provide, a new brace will need to be fitted. If your case is not a severe one, a single brace may be enough to correct your scoliosis – but many patients will end up paying for multiple braces, thus driving up longer-term costs when non-adjustable braces are used.

An alternative (albeit an alternative which will be slightly more expensive upfront) is an adjustable brace. Scolibrace falls into this category and allows for periodic adjustment and augmentation of the brace to allow it to follow along with your scoliosis correction. Patients with significant curves may still need more than one scolibrace, but by contrast, 3 or even 4 fixed shape braces would certainly cost more in its place.

In the picture below you can see the effect of a corrective brace pad reducing the curve from 13 degrees down to just 7.5.

 

4 – User-friendliness

An often-overlooked factor for scoliosis braces is the ease with which they can be put on, or taken off. Depending on your treatment protocol you may only need to wear your brace for a certain part of the day, only at night or may be able to take the brace off for physical activity. This is, of course, only possible if the brace is easy for the user to take it off, or put it back on!

Pay special attention to this factor if you live alone, or have children who require a brace, since a brace which is not correctly fitted will not do its job!

 

5- Style

While style probably isn’t the best criteria to judge the success of a brace by, compliance  – that is to say how often patients actually wear the brace – is certainly a major factor. Braces such as Scolibrace are available in a range of colours and patterns so that they can either be produced in a style which matches your own preference, or in colour designed to blend in under clothing, especially school uniform.

 

[1] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the

patients with adolescentidiopathic scoliosis in Mainland China? –A randomized controlled trial study

SPINE: An International Journal for the study of the spine [Publish Ahead of Print]

Wait and see, wait for treatment, wait for surgery…

The UK Scoliosis clinic blog isn’t a political platform, but it’s clear for anyone in the UK to see that in many areas, NHS waiting times are a real problem. What’s perhaps even more of a problem are waiting times to see specialists (and therefore the time to access proactive treatment)  – or indeed, time wasted on a “wait and see” approach to scoliosis progression. The problem is that scoliosis is a progressive condition – if caught early it can often be treated without surgery, but if you wait too long, your options can narrow.

 

Scoliosis, its progressive condition.

In most cases, scoliosis is a progressive condition – to be sure, there are some cases (mainly adult cases) where the risk of progression may be lower, but certainly, in children and young people, the rate of progression can be rapid.

Whereas cases of adult scoliosis (that is to say scoliosis which began in childhood and was carried into adulthood) increase in curvature by approximately 0.82° per year, the rate at which scoliosis increases in young patients depends upon risk factors such as the severity of scoliosis considering age, rigidity of curve, and family history. Research has demonstrated that Juvenile scoliosis greater than 30 degrees increases rapidly and left untreated presents a 100% prognosis for surgery, whereas curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[1]

With scoliosis, there is, therefore, a very real need to act quickly and proactively if the condition is to be halted and the curvature corrected before either surgery is required, or full correction is no longer possible.

 

Wait to see your GP

For most of us, the GP is the first port of call for all things medical – this is exactly how it’s supposed to be, and while we’re certainly not looking to criticise GP’s, there are a couple of points to keep in mind. Firstly, if you suspect scoliosis, consider the waiting time for a non-urgent appointment at your local doctor’s surgery – scoliosis suspected in younger patients can develop even over a few weeks, so no time should be spared in seeking an evaluation.

Secondly, it’s true that most GP’s do not have specialist training in Scoliosis – and where training is given, the message often reflects out of date attitudes to the condition – specifically, the outdated notion that scoliosis can only be effectively treated with surgery. Because of this, GP’s often lack the specialist training, time and knowledge of the treatments available to do anything other than refer you to a specialist, or, simply ask you to “wait and see”.

 

Wait to see a specialist

With any luck, a visit to your GP will net you an appointment to see a spinal specialist, who, when you finally do get an appointment, will certainly be able to diagnose scoliosis. The problem again is that you may wait many months for such an appointment, during which time scoliosis can continue to progress. Even once scoliosis has been diagnosed, many specialists will still recommend a further “wait and see” approach (which can sometimes last for years) in the hope that the scoliosis may resolve on its own. While this can happen in a very small number of cases, it is incredibly uncommon.

Some specialists are more sympathetic to scoliosis cases, and through training and awareness more and more health professionals are becoming aware of the non-surgical treatments available. You may be offered a brace to help stop scoliosis progressing at this point – but the options available through the NHS are currently limited.

 

Wait for surgery

Some specialists still take the view that scoliosis can only be treated surgically (this is false!) and other times you may be seen by a specialist once scoliosis has developed beyond 45 degrees, which is typically considered the threshold for surgery. Bracing and other non-surgical methods are certainly still possible up to 60 degrees however, and should still be considered.

Recent research by the British scoliosis society[2] has shown that even at this stage, most patients face another long wait for treatment during which scoliosis tends to progress. This 2018 study specifically looked at scoliosis progression whilst waiting for a consultation and eventual surgery. In the study, 41 females and 20 males with a mean age of 11.8 years with a mean Cobb angle (curvature) of 58° were followed –  Average waiting time to be seen in the clinic for an initial consultation was 16 months – thereafter, the average waiting time for surgery was 10 months. Rapid curve progression was seen in twelve patients, of which 10 required more extensive surgery than originally planned. Their mean Cobb angle at presentation was 48° which increased to a mean of 58° at surgery.

 

Scoliosis – DON’T WAIT!

The “wait and see” approach to scoliosis was once prevalent – based on the idea that scoliosis could only be treated with surgery, doctors justifiably took the view that it was better to hope that scoliosis would not progress too much, and would put off the decision to undertake surgery for as long as possible. Today, however, the choice is very different – modern clinics, like the UK Scoliosis clinic, specialise in the non-surgical treatment of scoliosis and can reduce and often totally eliminate scoliotic curves through non-invasive techniques such as active bracing and scoliosis specific exercise.

While we certainly would not discourage you from seeking an opinion from your GP if you have concerns about scoliosis, we strongly recommend that parents of children or teenagers with potential scoliosis also make an appointment with a scoliosis specialist. Rather than waiting months, perhaps years, a scoliosis specialist appointment can usually be arranged with a few weeks, and non-surgical treatment can begin almost immediately.

Perhaps the saddest part about the study from the British scoliosis society was the specific data on the curves of the participants at the beginning of the research. The range of curves studied was between 17°–90°[3], and while a 90-degree curve would certainly be likely to require surgery, a 17-degree curve would almost certainly have not – indeed, a 17 degree curve would be an excellent candidate for the kind of conservative, non surgical treatment we offer at the UK scoliosis clinic.

By the end of the study, the smallest curve was  30°and the largest was 120°. While it is certainly easier to treat a smaller curve,  a 30-degree curve still has a good prognosis with modern conservative treatment through active bracing, such as scolibrace.  This study goes to show that the right information at the right time makes a significant difference in scoliosis cases.  Indeed –  in stark contrast to the above – one recent study of 113 scoliosis patients treated with non-surgical approaches showed that vast majority achieved a significant curve correction and only  4.9% of patients needed surgery.[4]

If you have Scoliosis, or have a child with scoliosis – consider getting a second (or first) opinion from a scoliosis professional, whichever stage of the process you are at!

 

[1] Progression risk of idiopathic juvenile scoliosis during pubertal growth, Charles YP, Daures JP, de Rosa V, Diméglio A. Spine 2006 Aug 1;31(17):1933-42.

[2] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies, SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY?  Orthopaedic ProceedingsVol. 88-B, No. SUPP_II

[3] H V Dabke, A Jones, S Ahuja, J Howes, P R Davies, SHOULD PATIENTS WAIT FOR SCOLIOSIS SURGERY?  Orthopaedic ProceedingsVol. 88-B, No. SUPP_II

[4] ‘Brace treatment in juvenile idiopathic scoliosis: a prospective study in accordance with the SRS criteria for bracing studies –SOSORT award 2013 winner‘ Angelo G Aulisa, Vincenzo Guzzanti, Emanuele Marzetti,Marco Giordano, Francesco Falciglia and Lorenzo Aulisa, Scoliosis 2014 9:3 DOI: 10.1186/1748-7161-9-3

Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace

New research just published by our partner ScoliCare has once again gone to show that the ScoliBrace, coupled with an appropriate exercise regime can be effective not only in reducing scoliosis, but also in treating Scheuermann’s Kyphosis.

Regular readers of the blog will know that a treatable case of Scoliosis is considered to exist when the cobb angle (the bend in the spine) exceeds 10 degrees. Scoliosis causes the spine to bend “from side to side”.  In Scheuermann’s Kyphosis there is a malformation of the spinal vertebrae – specifically, they are slightly shorter in height at the front than at the back, leaving them slightly wedge-shaped – This leads to a “forward hunching” curve in the spine. While both conditions can and do frequently present independently, it is entirely possible for both to be present.

With respect to treatment for Scheuermann’s kyphosis and scoliosis, a course of conservative (that is to say, non-surgical) therapy is recommended wherever possible, with surgical intervention reserved for those patients with severe pain and/or disability at the time of the initial consultation or for individuals who have not responded to conservative management attempts.  The research from 2019 provided a case study of a patient in which both conditions were present, and were managed successfully with ScoliBrace, and appropriate exercise.

Let’s take a look at the recent case study[1] – both because we can learn something about the way that ScoliBrace can be used to treat these cases, but also because many readers may recognise something of their own experience!

 

Scoliosis and Scheuermann’s, a case study

Initial X-ray, taken at the start of treatment

On the 22nd of February 2016, a 26-year-old Caucasian male presented to a chiropractic clinic suffering with from lower back pain and poor posture. He also had a previous diagnosis of Scheuermann’s kyphosis and adolescent idiopathic scoliosis. The patient reported difficulty with prolonged standing and sitting, dissatisfaction with his cosmetic appearance, and difficulty with leisure activities – all of which are common issues for sufferers of both conditions.

Interestingly, the patient in question had not left his spinal conditions untreated – on the contrary, at the age of 15, the patient was referred to the local Children’s Hospital and was prescribed a hospital made thoraco-lumbo-sacral orthosis (TLSO) (a brace) which he wore full-time (23 hours per day) between the ages of 15–17 years.  Unfortunately, the brace provided was not like ScoliBrace, in that it’s action was preventative, rather than corrective – meaning that its objective was simply to hold his curves in place to avoid progression of the scoliosis, rather than to reduce it. The brace also had no effect on the Kyphosis.

At the point of initial examination, the patient reported that he was significantly unhappy with his physical appearance and rated his back pain as 4/10 on average and 7/10 at worst.

Full spine radiographic assessment was performed which revealed a thoracic hyper-kyphosis measuring 79° Cobb (Fig. 1), and a 30° Cobb lumbar scoliosis and sacral obliquity (Fig. 2). A loss of disc height, vertebral wedging and endplate irregularities were noted at several levels in the mid-thoracic spine. A true leg-length discrepancy (short left leg relative to the right) of 6 mm was also noted during the radiographic examination.

Subsequently, he was prescribed a ScoliBrace custom spinal orthosis, a rehabilitation program and a 6 mm heel lift. The ScoliBrace, unlike the Boston brace the patient was previously provide with, is an over-corrective brace, which takes and active approach to correction – this means that rather than simply trying to stop scoliosis progressing, it actually works to reduce the curve. The patients home exercises were simple for him to perform and included a mixture of stretching and strengthening exercises designed to oppose both undesirable curvatures.

 

12 months with ScoliBrace, results!

Follow up X-ray

Since the entire ScoliBrace process is designed to be flexible, reactive and adaptable, patients are typically seen every 6 months or so to assess progress and make any necessary treatment changes. Our patients first follow-up assessment was performed 4.5-months after the initial assessment. After just 18 weeks, the patient reported that, on average, he had been pain-free, with his worst occasional pain being rated as 2/10 pain on occasion.  In terms of the spinal deformity, the hyper-kyphosis had reduced by 16°, from 79° down to 63°, and the lumbar scoliosis curve was reduced by 5°, from 30° down to 25°.

At a further follow-up, 12 and a half months after the initial consultation, another series of x-rays showed that the postural improvements had all been maintained. An analysis of follow-up radiographic images (Fig. 6) showed a maintenance of the original postural improvements. [2]

 

 

Treating Scoliosis and Scheuermann’s at the UK Scoliosis clinic

The above case study results are interesting, because fairly few studies have addressed the use of active correction braces in adults, and there is also very little research on the correction of both conditions simultaneously. This case study certainly suggests that ScoliBrace, coupled with targeted home exercise can indeed have a positive impact on these conditions.

Of note is also the fact that this is yet another study to indicate a link between scoliosis and pain. At the UK Scoliosis clinic, we have long observed that pain and discomfort are often associated with these conditions, even if research has yet to confirm this association in an absolute sense. It would be fair to mention on this point that much of the research that would go to establish the validity of bracing as an approach to pain reduction have been affected by low adherence of study participants to their prescriptions – which is a common issue for many studies in bracing.[3]

At the UK Scoliosis clinic, we also offer the Kyphobrace system (from the same developers as scolibrace) which is ideal for treating Kyphosis cases which occur without scoliosis. To learn more, click here.

 

 

[1] Christopher M. Gubbels, DC, Paul A. Oakely, DC, MSc, Jeb McAviney, MChiro, MPainMed, Deed E. Harrison, DC, Benjamin T. Brown, PhD,  Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: a case report, J. Phys. Ther. Sci. 31: 159–165, 2019

 

[2] Christopher M. Gubbels, DC, Paul A. Oakely, DC, MSc, Jeb McAviney, MChiro, MPainMed, Deed E. Harrison, DC, Benjamin T. Brown, PhD,

Reduction of Scheuermann’s deformity and scoliosis using ScoliBrace and a scoliosis specific rehabilitation program: a case report, J. Phys. Ther. Sci. 31: 159–165, 2019

 

[3] See for example Weiss HR, Moramarco K, Moramarco M: Scoliosis bracing and exercise for pain management in adults—a case report. J Phys Ther Sci, 2016, 28: 2404–2407.

Palazzo C, Montigny JP, Barbot F, et al.: Effects of bracing in adult with scoliosis: a retrospective study. Arch Phys Med Rehabil, 2017, 98: 187–190.

Is scoliosis a risk factor for mental health?

Like all reputable clinics, the UK scoliosis clinic focuses the majority of its time and effort on providing the best possible treatment for scoliosis cases. For the most part, this means keeping up with the latest research, bracing and exercise based techniques which can assist in controlling and reducing scoliosis, however, where we also concentrate a lot of time and attention is to the psychological aspects of living with and being treated for scoliosis.

 

Scoliosis and Psychological factors

Like any condition, Scoliosis can obviously cause distress and concern – but there are some specific factors associated with scoliosis which may make the condition especially difficult for many patients to cope with. The key areas include:

  • The fact that Scoliosis does cause physical deformity, and very often strikes at the most sensitive time in a young person’s life. It’s normal and expected for teens and young adults to experience stress and difficulty associated with physical changes in their body and the formation of their adult identity, even under typical circumstances – scoliosis can certainly complicate this.
  • Misinformation about scoliosis which is frequently repeated. Many still believe that a diagnosis of scoliosis necessitates surgery, which, ironically, can prevent some people from taking advantage of screening. It’s also commonly believed that scoliosis can impact on the ability to have children, take part in physical activity or even live a normal life. While it’s true that if left untreated scoliosis could lead to some of these outcomes, early treatment can often make such outcomes almost completely avoidable.
  • Concerns about bracing, and stigma associated with bracing. It’s certainly the case that “old style” braces such as the Boston brace were visible, clunky and certainly embarrassing for young people – but modern CAD/CAM braces, such as ScoliBrace, are virtually invisible under clothing.
  • Fear of being unable to participate in normal activities. Again, with modern bracing technology this is rarely if ever, an issue – today’s braces are so easy to put on and take off that they can simply be removed for exercise, although designs such as ScoliBrace are actually flexible enough to be left on.

With each of these concerns, the critical point to stress is that Scoliosis, if caught early enough can now usually be treated non-surgically and quite quickly, through bracing, exercise or a combination of both. The best possible way to detect scoliosis is through a routine screening, which can often allow the condition to be detected long before it has progressed to a significant degree.

 

Scoliosis and psychological health : scientific research

There has been some limited research which has sought to understand the impact that scoliosis can have on a young person’s psychological health – although it’s still fair to say that only a small part of the literature relating to scoliosis considers this angle, there is still sufficient a body of evidence for us to draw some meaningful conclusions.

One such study looked at adolescents with and without scoliosis in Minnesota who were 12 through 18 years of age. During the study, six hundred eighty-five cases of scoliosis were identified from the 34,706 adolescents. The prevalence was therefore 1.97%  (incidentally, this is slightly below the average figure). The researchers wanted to calculate the odds ratio of scoliosis to some common psychological issues.

Put simply, an odds ratio is a measure of how strongly related two items are – An odds ratio of more than 1 means that there are a higher odds of property B happening with exposure to property A, whereas an odds ratio of exactly 1 means that exposure to property A does not affect the odds of property B. An odds ratio is less than 1 is associated with lower odds of two factors being related. [1]

In the study, of the 685 adolescents with scoliosis, the odds ratio for having suicidal thought among adolescents with scoliosis, compared to adolescents without scoliosis, was 1.40 after adjustment for race, gender, socioeconomic status, and age. The odds ratio for having feelings about poor body development among adolescents with scoliosis was 1.82 compared with adolescents without scoliosis after adjustment for race, gender, socioeconomic status, and age. Scoliosis was therefore deemed to be an independent risk factor for suicidal thought, worry and concern over body development, and peer interactions.

In a 2019 study, which compared scoliosis treatment approaches, the SRS-22 (a standardised scoliosis quality of life screening form) was used to explore the impact which treatment had on psychological health.  Here, researchers noticed that self-image was significantly improved amongst patients treated with a scoliosis brace, especially at a follow up after 12 months of treatment, this was especially interesting given the negative self-image association which is sometimes linked to bracing

Researchers found a similar improvement in patients treated with an exercise methodology –  all the SRS-22 quality of life subsets showed a slightly larger improvement across the three visits than bracing, although the correction of scoliosis was less.[2]

 

Does scoliosis affect psychological health?

From the research which has been conducted, as well as our own experience at the clinic we feel it’s safe to say that scoliosis can be a significant risk factor for psychological health – especially in young people. While this certainly does not mean that everyone with scoliosis will struggle with mental health as a result, it’s clearly important that scoliosis clinicians are aware of the risk, and work to mitigate it.

At the UK Scoliosis clinic, we believe that properly researched information, coupled with effective treatment, applied as quickly as possible is the best possible way to address the psychological risks associated with scoliosis. It’s for this reason that we continue to recommend frequent screening throughout high risk years. It cannot be stressed enough that early detection, coupled with good information can go the majority of the distance in diffusing some of the  main concerns around a scoliosis diagnosis. We would caution parents and sufferers from relying on general advice or information pulled from the internet – the best option is by far a consultation with a scoliosis professional.

[1] Payne, William K. III, MD, et al. Does Scoliosis Have a Psychological Impact and Does Gender Make a Difference? Spine: June 15, 1997 – Volume 22 – Issue 12 – p 1380–1384

[2] Yu Zheng, MD PhD et al. Whether orthotic management and exercise are equally effective to the patients with adolescent idiopathic scoliosis in Mainland China? – A randomized controlled trial study SPINE: An International Journal for the study of the spine [Publish Ahead of Print]

Study suggests bracing is also effective in early-onset scoliosis patients

While the majority of studies on scoliosis bracing focus primarily on adolescent scoliosis sufferers, there are many other groups who do suffer from scoliosis in significant numbers. Over the last few weeks, we have looked at scoliosis treatment in older individuals -this week we’re examining the best options for very young (infantile or juvenile) patients.

Today, scoliosis in infants and juveniles is treated either with serial casting or with a bracing approach (bracing usually in children at the older end of the age range.)  Serial casting – where a child is placed in a series of casts, with the goal of correcting scoliosis has often been the preferred approach, since early-onset of scoliosis (EOS) patients are skeletally immature and have the largest potential for fast recovery through non-operative treatments[1]. As bracing technology has improved however, it has also become common practice for bracing to be prescribed after casting to maintain the initial correction. Bracing is now also prescribed to patients who are not able to tolerate casting[2] – but new research is now beginning to explore bracing as a “first choice” option for younger patients.

Such studies are welcome since overall, bracing studies are usually done on AIS patients, which means that while there is a strong case to be made for bracing in other groups, it has been slow to assemble the scientific proof of concept. A recent study from 2019 has now added significantly to our understanding of bracing in younger patients and is (so far as we are aware) the first study to explore the effectiveness of CAD/CAM bracing approaches in very young patients.

 

Bracing in young children – new research

The study[3], conducted at Children’s Hospital of Wisconsin sought to understand how effective a customised over-corrective brace (like ScoliBrace) was in treating scoliosis in young patients with Infantile scoliosis (IS) and Juvenile scoliosis (JS).

Thirty-eight patients (22 males, 16 females; 17 IS, 21 JS) were recruited for this study. 9 children were diagnosed with neuromuscular scoliosis, 1 congenital scoliosis, and 28 with IS or JS. The average age was 6.2 years old (ranging from 4 months to 10-years-old). Criteria for inclusion included:
1) All subjects are diagnosed with IS or JS (idiopathic, neuromuscular, or congenital);
2) Subjects must have not had any type of spinal surgery prior to bracing treatment;
3) Must be under 10 years old during the time of their first scan;
4) Must have had at least one follow up visit after their baseline scan before the 12-month mark.

During the trial, investigators utilised 3D scanning technology (similar to BraceScan) to map the exact requirements for the scoliosis brace for each patient – this was then manufactured using a CAD/CAM approach, facilitating a very high degree of accuracy. At an initial fitting, a scoliosis specialist checked that the brace was functioning as required and made any small adjustments necessary.

Overall, amongst the patients as a group the starting Cobb angle was 38 ± 14° in the thoracic curve (ranging from 19° to 68°), 30 ± 9.6° in the thoracolumbar (ranging from 19° to 42°), and 36 ± 10.3° in the lumbar sections (ranging from 22° to 53°).

 

Results in younger patients

After brace fitting, the investigators followed the patients for 12 months, with a view to assessing change in Cobb angle.  Firstly, no patients required surgery within the 12-month span, whereas without bracing surgery may have been necessary at least in a few cases.

When compared to the baseline measurements, the in-brace correction reduced the Cobb angle in the patients from 38° to 24.2° in the thoracic region (a 36.3% reduction), 30° to 10.3° in the thoracolumbar region (a 65.7% reduction), and from 36° to 18.5° in the lumbar (a 48.3% reduction). The juvenile group had 23% correction, 47% stabilization, and 30% progression of curves. The infantile group had 50% correction, 32% stabilization, and 18% progression of curves. The following table shows the progress over a series of three-month evaluations.

 

Levels of Curve Month Cobb Angle (°) Curve change (°) % Change
Thoracic 0 38.0 ± 14.0 NA NA
3 30.1 ± 19.7 −5.6 −15.6%
6 30.2 ± 21.5 −5.5 − 15.5%
9 31.5 ± 24.2 −4.2 −11.6%
12 29.4 ± 24.3 −6.2 −17.5%
Thoracolumbar 0 30.0 ± 9.6 NA NA
3 25.2 ± 11.2 0.2 0.6%
6 24.8 ± 11.6 −0.2 −0.9%
9 24.3 ± 10.3 −0.7 −2.7%
12 23.9 ± 10.0 −1.1 −4.5%
Lumbar 0 36.0 ± 10.3 NA NA
3 25.4 ± 14.3 −3.5 −12.2%
6 27.9 ± 14.5 −1 −3.5%
9 30.2 ± 14.2 1.3 4.5%
12 29.9 ± 14.2 1 3.6%

 

 

Is Bracing effective in young patients?

While (as we mentioned at the outset) there have been few in-depth studies considering the effectiveness of bracing in younger patients, the research presented here certainly suggests that the positive results which are typically seen in adolescents can be replicated in younger children.

Overall, the bracing approach used was shown to be effective in correcting nearly half of the thoracic curves and one-third of the other curves, over a period of 12 months. When combining all data, 75% of curves were corrected or stabilized.

As well as being effective, a bracing approach also has significant benefits in terms of quality of life, and cost-effectiveness. Since younger children with scoliosis experience such rapid spinal growth and development, traditional casting needs to be repeated every couple of months – This may be less cost-effective and less patient-friendly because visits are more frequent and may require plaster casting to be done with the patient under general anaesthesia. Bracing, by contrast, requires only a single fitting & fewer follow up visits The brace can also be removed for daily washing which is better for the infants skin and hygiene. As the child grows and changes shape, further braces may be required to treat the scoliosis effectively.

If you would like to know more about bracing in younger children, please contact us.

 

 

[1] Mehta MH. Growth as a corrective force in the early treatment of progressive infantile scoliosis. J Bone Joint Surg Br. 2005;87:1237–47.

[2] Weinstein SL, et al. Effects of bracing in adolescents with idiopathic scoliosis. N Engl J Med. 2013;369:1512–21.

[3] John Thometz, XueCheng Liu, Robert Rizza, Ian English and Sergery Tarima, Effect of an elongation bending derotation brace on the infantile or juvenile scoliosis, Scoliosis and Spinal Disorders 2018 13:13