Tag: Scoliosis bracing

The advantages of Scoliosis Bracing

Posted on April 27, 2023 by - Blog

Scoliosis is a condition characterised by an abnormal curvature of the spine, which can cause pain, discomfort, and even breathing difficulties. Scoliosis bracing is a non-surgical treatment option that involves wearing a brace to stabilise and/or correct the curvature of the spine. While bracing may not be a cure for scoliosis, it has many advantages that make it an effective treatment option. Research shows that the use of modern, custom designed Scoliosis braces can prevent the need for surgery in most cases[1].

While Scoliosis bracing is a fantastic approach to treatment, it does come with some downsides – bracing takes time and commitment, and can be an adjustment especially for a young person. Similarly, while bracing is a cost-effective treatment over a period of time, Scoliosis braces can be expensive and represent a significant up-front cost for some families. The disadvantages however usually outweighed by the benefits!

 

Bracing Slows the Progression of Scoliosis

The primary advantage of scoliosis bracing is that it can slow down the progression of scoliosis in most instances.[2] When used correctly (and when a modern brace is used) it’s often possible to not only stop the progress of Scoliosis but also to reverse the condition – often by a considerable amount.[3]

Bracing is also more effective than alternative non-surgical approaches, such as exercise based therapy.[4] In children and adolescents with moderate to severe curves, bracing can reduce the likelihood of the curve getting worse and the need for surgery. The brace helps to apply pressure on the spine, which helps to straighten the curvature and prevent it from progressing further.

 

Bracing is a Non-Invasive Treatment

Another advantage of scoliosis bracing is that it is a non-invasive treatment option. Unlike surgery, which involves cutting into the body and a long recovery time, bracing involves wearing a brace for a set period. The brace is designed to be worn under clothing and is not visible, so it does not need to impact daily life to a considerable extent. This makes bracing an excellent option for those who want to avoid surgery or cannot undergo surgery due to medical reasons.

 

Bracing Helps Improve Body Image

Scoliosis can cause a visible deformity in the spine, which can impact self-esteem and body image. Bracing can help improve body image by correcting the curvature of the spine, which can make the deformity less noticeable. For children and adolescents who may be self-conscious about their appearance, bracing can help boost confidence and self-esteem in the long term. Similarly, bracing in Adults who suffer pain or postural issues due to Scoliosis can improve movement and therefore independence and confidence.

 

It Provides Pain Relief

Scoliosis can cause back pain and discomfort, which can impact daily activities. Bracing can help to relieve pain and discomfort by applying pressure on the spine, which can reduce the strain on the back muscles. Bracing is often best combined with a Scoliosis specific exercise plan for this purpose – in combination, the two can lead to improved mobility and a better quality of life.

 

It’s a Customisable Treatment

Each scoliosis case is unique, and as such, each brace must be tailored to the individual. Early braces lacked the ability to be highly customised, but thanks to modern CAD/CAM techniques, current braces like Scolibrace can be fully customised to fit the unique curvature of the spine, ensuring that the brace is effective in treating scoliosis. This customisable treatment approach means that bracing can be an effective treatment option for a wide range of scoliosis cases.

 

Is Scoliosis bracing right for me?

Scoliosis bracing is a flexible and dynamic approach to treating scoliosis which is appropriate in many cases – both older and younger people can and do utilise Scoliosis braces to treat Scoliosis and its effects. Similarly, a range of Scoliosis types can be supported with modern braces making it an excellent option for a huge variety of people.

If you would like to learn more about Scoliosis and Scoliosis bracing, why not sign up for our free information series here.

 

 

 

[1] ‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’   [Results of the BrAIST Clinical Trial]
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

 

[2] ‘Effects of Bracing in Adolescents with Idiopathic Scoliosis’   [Results of the BrAIST Clinical Trial]
Stuart L. Weinstein, Lori A. Dolan, James G. Wright, and Matthew B. Dobbs, N Engl J Med 2013; 369:1512-1521 October 17, 2013DOI: 10.1056/NEJMoa1307337

 

[3] 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

[4] 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]

 

How to choose clothes with your Scoliosis Brace

Posted on April 20, 2023 by - Blog

Scoliosis is a condition that affects the spine, causing it to twist and curve sideways. It is often treated with a brace, which is worn around the torso to support the spine and prevent the curvature from worsening.

 

Scoliosis Braces

Modern Scoliosis Braces, such as the ScoliBrace which we offer at the UK Scoliosis Clinic are nothing like braces from the past – they are lightweight, low profile and even come in a wide variety of colours. Many people actually choose to wear their scoliosis brace as a sort of accessory – and with so many design patterns available, why not! Many people, however do prefer to keep their brace covered for all sorts of reasons. Moving about in a Scoliosis brace isn’t a huge issue, but choosing the right clothes can help with making the process as comfortable as possible – with a few tips and tricks, it is possible to find clothes that are both stylish and practical for all sorts of situations.

 

Tips and tricks!

Without further ado, here are the tips and tricks you need!

Look for clothes with stretchy or adjustable waistbands.

One of the most important things to consider when choosing clothes with a scoliosis brace is the waistband. The brace will add bulk to your midsection – and although it’s a small amount if you want to be able to wear clothes both with the brace on and off it is essential to choose clothes with waistbands that are stretchy or adjustable. Trousers with elastic waistbands or drawstring waists are obviously comfortable, but slightly stretchy options, like leggings, also work fine.

 

Avoid clothes with tight-fitting or restrictive waistbands.

On the flip side, it is best to avoid clothes with tight-fitting or restrictive waistbands, as they can be uncomfortable and even painful when worn with a scoliosis brace. This includes high-waisted pants, tight skirts, and tight-fitting shorts. Instead, opt for looser-fitting clothes that will allow for some movement and flexibility.

 

Choose clothes that are easy to put on and take off.

Putting on and taking off clothes can be a challenge when you are wearing a scoliosis brace – putting the brace on is easy (if you’re using a ScoliBrace!) but once you have the brace on it’s not possible to move the spine a great deal. Therefore, it’s best to choose clothes that are easy to put on and take off. This includes clothes with wide necklines, open fronts, and loose-fitting sleeves. Avoid clothes with tight or restrictive necklines, as these can be difficult to get over your head.

 

Look for clothes with extra room in the back.

Since the scoliosis brace will add bulk to your back, it is essential to look for clothes with extra room in the back. This includes jackets, blouses, and dresses with a loose or flowing back. Avoid clothes with tight or fitted backs, as they can be uncomfortable and restrict movement. With oversized clothing being in fashion, oversized fleeces, sweatshirts or hoodies worn with baggy joggers or leggings will keep adolescent girls feeling comfortable and looking on trend.

 

Choose clothes made from soft and breathable fabrics.

When choosing clothes to wear with a scoliosis brace, it is important to choose clothes made from soft and breathable fabrics. This includes cotton, linen, and bamboo fabrics, which are gentle on the skin and allow for air circulation. Avoid clothes made from synthetic fabrics, as they can be uncomfortable and trap sweat.

 

Consider layering your clothes.

Layering your clothes can be a great way to add warmth and style while wearing a scoliosis brace. Start with a soft, breathable base layer, such as a cotton tank top or t-shirt. Then, add a loose-fitting blouse or sweater on top. This will allow you to adjust your layers depending on the temperature and will provide some coverage for your brace.

 

Try on clothes with your brace.

Before buying any clothes, it is essential to try them on with your scoliosis brace. This will allow you to see how the clothes fit and feel with the brace, and you can make any necessary adjustments. If possible, try on clothes in a dressing room that has a full-length mirror, so you can see how the clothes look from all angles.

 

 

Should I remove my brace before a progress X-ray?

Posted on February 17, 2023 by - Blog

X-rays are the gold standard when it comes to diagnosing scoliosis and tracking the progress of treatment for the condition. Scoliosis is notoriously difficult to gauge from a visual inspection alone, meaning that regular X-rays are critical to ensuring that treatment is progressing as expected and that any adjustments to a patient’s brace are made at the correct time. In the usual course of treatment, Scoliosis professionals take X-rays every 6-12 months with these goals in mind – which often leaves patients asking, should I take my brace off before the X-ray?

 

In-brace vs out of Brace correction

What’s important to understand is that a Scoliosis Brace provides better correction while being worn than not being worn – that might sound obvious but it’s important to remember that the role of the brace is to correct, or often, over correct Scoliosis, in order that over time the spine is corrected when the brace is removed.

When you put a Scoliosis brace on, research suggests that it takes around 2 hours[1] to reach the maximum correction that can be obtained by using a brace. After removing, the correction obtained is gradually lost over around 2 hours, after which the curve/spine stabilizes[2]  Over time, the goal of Scoliosis treatment is to reduce the amount that correction is lost when the brace is removed – over corrective braces, such as ScoliBrace achieve this by adding corrective force to he spine to help to move it towards its proper position.

 

Braces and X-rays

So, should you remove your brace before a progress X-ray?  Taking the brace off, perhaps even days before the X-ray gives a truer picture of what’s “really” happening with the spine – but tells us little about how much correction the brace itself is providing. By contrast, leaving the brace on during the X-ray, or removing it right before gives us an excellent idea of how well the brace is working (and whether it’s time to adjust it), but isn’t as good at showing us how the spine might look after hours, or days of no wear. A good compromise is often an in-brace X-ray, followed by an out-of-brace X-ray after a short break which can give an idea of in-brace correction, and allow us to approximate an out-of-brace figure.

Nonetheless, it’s a complex issue, and for these reasons, at present, there’s no defined standard for the best way to carry out progress X-rays – generally speaking, it’s up to the Scoliosis practitioner to decide how to perform X-rays, based on the specific needs of the patient.

But let’s not forget the most important fact about Scoliosis bracing – it’s a treatment method which works over time – for this reason, we’re often less concerned with the exact method used to take progress X-rays, and more with the fact that the x-rays are performed in a consistent way. That is to say, during treatment, we care less about the exact degree of correction and more about the direction of travel.

 

Should I remove my brace before a progress X-ray?

The answer to the question is simply… do as your practitioner suggests! When to remove, or not remove the brace isn’t an issue that you as a patient need to worry about – but you should make sure that you comply with the instructions you’re given, and that you do so each time you visit for a progress X-ray. Rember, it’s consistency which matters!

 

 

 

[1] Katarzyna Zaborowska-Sapeta et al. The Duration of the correction loss after removing cheneau brace in patients with adolescent idiopathic scoliosis Acta Orthopaedica et Traumatologica Turcica 53 (2019)

[2] Meng Li  1 , M S Wong, Keith D K Luk, Kenneth W H Wong, Kenneth M C Cheung, Time-dependent response of scoliotic curvature to orthotic intervention: when should a radiograph be obtained after putting on or taking off a spinal orthosis?  Spine (Phila Pa 1976). 2014 Aug 1;39(17):1408-16.

Bracing Scoliosis over 45 degrees

Posted on July 25, 2022 by - Blog

For many years it was considered to be the case that surgery was the only option for reversing Scoliosis – while Scoliosis braces did exist, their primary function was simply to stop Scoliosis from progressing. The best outcome available from bracing was therefore to slow Scoliosis down enough that a patient reached adulthood with a tolerable curve.

Today, modern Scoliosis braces have the ability not only to stop the progression of Scoliosis but also to reverse the condition. Such “over corrective” braces, such as the ScoliBrace we offer at the UK Scoliosis Clinic do this by applying gentle pressure to the scoliotic curve in the opposite direction to the curvature – over time, this can gradually help the spine to return to proper alignment. The success of bracing treatment depends on several factors – one of the most important being the flexibility in the spine, however, it’s possible for patients with Scoliosis up to around 60 degrees[1] to see excellent correction when they are young and flexible enough.

Nonetheless, the “wait and see” followed by surgery approach is still common today, which means Scoliosis patients should always do their research and explore their options before committing to a specific course of treatment.

 

When to brace

When to brace a Scoliosis curve is a tricky question, and one of the major benefits of seeing a Scoliosis specialist – very small curves may not need bracing, with an exercise methodology being enough to control the condition. Larger curves, but those under roughly 30 degrees could benefit from either bracing or exercise-based approaches, so the patient’s lifestyle factors and preferences start to play an important role in treatment selection. For curves over 30 degrees Cobb (Cobb angle being the way in which Scoliosis is measured), bracing is usually the best way forward – however many patients with curves over 45 degrees are often recommended a surgical approach, is this the only option?

 

Bracing curves over 45 degrees – study results

A 2011 study[2] looked specifically at treating Scoliosis patients who were recommended surgery but declined it. The purpose of the study was to verify if it was possible to achieve improvements of scoliosis of more than 45° through a complete conservative treatment – in most cases, this means a combination of bracing and exercise. Specifically, the methods comprised full-time treatment (23 or 24 hours per day) for 1 year with Risser cast, Lyon, or Sforzesco brace; weaning of 1 to 2 hours every 6 months; with strategies to maximize compliance through the Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) management criteria applied and specific scientific exercises approach to scoliosis exercises (SEAS) performed.

Out of 1,148 idiopathic scoliosis (IS) patients at the end of treatment, the sample comprised 28 subjects older than 10 years, still growing, with at least one curve above 45°, who had continually refused fusion. The group comprised 24 females and four males, including 14 in which previous brace treatments had failed; at the start of treatment, the age was 14.2±1.8 years and Cobb degrees in the curve were 49.4° (range, 45°-58°). Subgroups considered were gender, bone age, type of scoliosis, treatment used, and previous failed treatment.

After the course of treatment, two patients (7%) remained above 50° Cobb but six patients (21%) finished between 30° and 35° Cobb and 12 patients (43%) finished between 36° and 40° Cobb. Improvements were therefore found in 71% of patients, with only a single 5° Cobb progression observed in one patient. As such, the conclusion was that bracing can be successfully used in patients who do not want to undergo operations for Scoliosis, with curves ranging between 45° and 60° Cobb, given sufficient clinical expertise to apply good braces and achieve great compliance.

 

Is bracing always the right choice for larger curves?

Weather bracing is the right choice for any given curve depends very much on the patient – as studies like this show it’s certainly possible to achieve great results without undergoing surgery – however, the spine needs to be sufficiently flexible and there needs to be time before skeletal maturity is reached still remaining so that treatment has time to work. A consultation with a Scoliosis specialist is always the best way forward when dealing with a suspected or confirmed Scoliosis case, but today it’s certainly true that there are far more tools we can use to prevent and treat Scoliosis than ever before.

 

 

 

[1] Maximum indicated cobb angle for ScoliBrace

[2] Stefano Negrini  1 , Francesco Negrini, Claudia Fusco, Fabio Zaina, Idiopathic scoliosis patients with curves more than 45 Cobb degrees refusing surgery can be effectively treated through bracing with curve improvements Spine J. 2011 May;11(5):369-80.doi: 10.1016/j.spinee.2010.12.001. Epub 2011 Feb 2.

Do curves continue to grow after bracing?

Posted on July 15, 2022 by - Blog

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

 

Scoliosis Bracing in Older Adults, New Research

Posted on June 24, 2022 by - Blog

If you’ve been following the blog this Scoliosis Awareness month, you’ll know that Adult Scoliosis is generally defined as any scoliosis case that exists either in those over 18, or those having reached skeletal maturity – either definition is valid but most scoliosis specialists would prefer the latter since we are focused more on the condition itself than an arbitrary point of “adulthood.”

There are two main types of adult scoliosis. Pre-existing adult scoliosis is essentially a case of scoliosis which is continuing from an earlier age (usually adolescent scoliosis). In adulthood, a continuing case of scoliosis typically becomes known as Adolescent Scoliosis in Adults or ASA. ASA can be discovered in adults of any age, but many ASA cases are already known from treatment earlier in life.

The second type is Degenerative De-Novo Scoliosis– this is the development of a new scoliosis case, usually as a result of spinal degeneration.

Much recent (and not so recent) research into scoliosis treatment, especially bracing, has focused on younger patients – this is primarily because this group stands to gain the most from bracing – proper treatment of, say a 15 year old with mild to moderate scoliosis stands a good chance of allowing him or her to live the rest of their life free of the condition. Those who have reached adulthood with a scoliotic curve, or develop one through ageing have less of a chance for improvement in the cobb angle (degree of scoliosis) but equally, lower rates of progression in the curve itself. Bracing, however, has been shown to have positive effects for older individuals, primarily around daily function and pain reduction. A recent literature review of relevant studies has confirmed this view.

 

What causes Scoliosis in Adults?

Since there are two kinds of scoliosis in adults, we should take a moment to understand why and how they are different.

ASA is scoliosis carried into adulthood from adolescence, isn’t caused in adulthood – it may or may not worsen depending on a number of factors, but the condition originated at an earlier point in life.

Degenerative scoliosis, by contrast, does occur in adult life and is attributable to wear and tear on the spine, but is also strongly associated with a variety of conditions. Osteoporosis, degenerative disc disease, compression fractures and spinal canal stenosis have all been implicated in the development of degenerative scoliosis.

Since De-Novo scoliosis is a consequence of spinal degeneration with age, it rarely presents before 40 years of age. For many patients, drawing a distinction between the two types may be academic at any rate, since in patients with no known history of scoliosis it may well be impossible to say whether a newly discovered case is a Do-Novo one, or ASA. It is thought that as many as 30% of over 60’s suffer from De-novo scoliosis[1], although a percentage of these cases will be undiscovered scoliosis from earlier in life. In fact, a good number of adult scoliosis cases are discovered through an investigation for another condition (such as back pain).

 

Recent study

The newest study[2] taking a broad view of the literature on scoliosis bracing for older adults was a review of relevant papers published between 1967 and 2018 – the study investigators used standardised criteria to select relevant papers for inclusion in their work.

In total, ten studies (four case reports and six cohort studies) were included which detailed the clinical outcomes of soft (2 studies) or rigid bracing (8 studies), used as a standalone therapy or in combination with physiotherapy/rehabilitation, in 339 adults with various types of scoliosis. Most studies included female participants only. Right away, this shows one of the biggest issues with Scoliosis research, especially in older adults – there is a clear gender bias (probably due to the higher incidence of adolescents in females, about 75% of cases) and overall a lack of research, only 8 studies considering rigid bracing of the kind now most frequently employed isn’t a huge number!

In the studies, brace wear prescriptions ranged from 2 to 23 hours per day, and there was mixed brace wear compliance reported, both are consistent with our actual experience of bracing in older adults. Most of the included studies reported modest or significant reduction in pain and improvement in function at follow-up. There were mixed findings with regards to Cobb angle changes in response to bracing.

 

Study conclusions

After their review, the study authors reported some key conclusions which are well worth noting. Firstly, they showed that there is evidence to suggest that spinal brace/orthosis treatment may have a positive short – medium-term influence on pain and function in adults with either de novo degenerative scoliosis or progressive idiopathic scoliosis. This finding essentially supports the use of bracing in older adults and tallies with our own experience in helping older patients to reduce and manage pain as well as improve function through bracing.

Secondly, and importantly, it was noted that a particular focus on female patients with thoracolumbar and lumbar curves made it difficult to make firm conclusions on the efficacy of bracing for males, and other curve types. It would therefore be highly desirable for further research in this area to focus on a wider variety of case types, in order for us to better understand treatment pathways for older individuals.

 

[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.

[2] Jeb McAviney et al. A systematic literature review of spinal brace/orthosis treatment for adults with scoliosis between 1967 and 2018: clinical outcomes and harms data BMC Musculoskeletal Disorders volume 21, Article number: 87 (2020)

Scoliosis awareness month – Adolescent Scoliosis

Posted on June 14, 2021 by - Blog

Most of the Scoliosis cases we treat at the clinic – and indeed, most of the scoliosis cases discovered are categorised as adolescent idiopathic scoliosis (often called AIS) That’s to say, scoliosis in a person older than 10, but who has not yet reached skeletal maturity, and a case without obvious cause, such as congenital or syndromic issues, or trauma.

Whereas infantile and younger Juvenile scoliosis cases are common in boys, 80% of all AIS cases are girls. It is usually noticed around 11-12 years of age in girls and slightly later when diagnosed in boys.  AIS is estimated to affect between 3 and 4% of teenagers. In most cases, AIS begins to develop noticeably at the initial onset of puberty and becomes more apparent as it worsens during growth spurts. AIS can be highly progressive, so it is important that the right sort of monitoring and treatment is sought as soon as the condition is noticed. When not appropriately treated it may result in significant deformity, physical disability and psychological issues – but when treated with effective modern approaches, the prognosis – as showed by the BrAIST study, is good – with as many as 90% of patients who comply with bracing prescriptions avoiding surgery[1]

 

What causes AIS?

Like all forms of idiopathic scoliosis, the exact cause of AIS is unknown. Like other forms, there have been a large number of possible causes suggested – one of the leading theories is a genetic link, although more research is required before we are able to make a definitive conclusion.

There is also some evidence that AIS may be associated with certain activities which stress and pull the spine away from its normal aligned position – for example, research indicates a higher incidence of scoliosis in ballet dancers and gymnasts, although it’s important to note that this does not necessarily mean that these activities cause Scoliosis, only that more cases are being detected (this could feasibly be simply because we’re looking for them more frequently).

It’s also worth clarifying that while scoliosis does cause postural issues, poor posture does not cause scoliosis, and nor (so far as the current research suggests) does diet.

 

What is the prognosis for AIS Scoliosis?

The prognosis for an AIS case depends on a number of key factors – the significance of the curve at the time of discovery, the flexibility of the curve, the age of the patient and the ability of the patient to comply with ongoing treatment.

The larger a curve is at discovery, the more work needs to be done to correct it – Bracing has been shown to be effective up to 60 degrees, but an ideal candidate is in the 20-40 degree range. Closely tied to this is the rigidity of the curve – that is to say how flexible the spine is, and therefore how likely we are to succeed with an approach such as bracing, which aims to gently guide the spine back to a correct alignment. A flexible curve is much easier to treat than a rigid one.

The age of the patient is important for two reasons – firstly, while scoliosis development does not always stop in adults, where it does continue it tends to slow and become predictable – developing at about 1 degree per year. Therefore a small curve in an individual close to adulthood has less time to progress to a significant degree, than does a large curve in a younger child. What’s more, research suggests that curves that are still small at adulthood do not continue to develop[2]

Secondly, it’s also long been thought that scoliosis worsens faster around growth spurts[3] – hence an older adolescent who has almost reached their full growth has less exposure to this potentially aggravating factor.  More recently, however, we have come to understand aspects such as the Risser sign (an indication of skeletal maturity) and the onset of menstruation are closely correlated with the potential for curve increase regardless of “growth spurts”. Immature children (Risser sign 0 or 1) with larger curves (20–29°) at initial diagnosis demonstrated a 68% risk for curve progression, whereas mature children (Risser 2–4) with similar curves at initial presentation had a 23% risk for curve progression. Conversely, immature children with smaller curves (5–19°) demonstrated 22% chance for curve progression, while mature children with smaller curves had only a 1.6% risk for curve progression.[4]

In both cases, we would like to detect and control curves in patients at the earliest possible opportunity, as this allows us to stabilise curves, and prevent progression throughout growth, and maximise the chance for curve correction and the avoidance of future issues in adulthood.

It’s for this reason that early screening and detection is so important in scoliosis cases – it’s too simplistic to say that cases that are detected early are guaranteed a better outcome, but by spotting cases as early as possible, you certainly allow the maximum number of options for treatment.

 

How can we treat AIS?

The best treatment for a scoliosis case depends on all of the above factors – but for simplicity, let’s take the question just by curve size. It’s important to remember that factors such as age and curve flexibility may modify this rough outline.

In curves between 10-20° scoliosis, specific exercises – a physiotherapy based approach to treatment – are typically recommended as an initial approach, while bracing may also be used as a preventative measure in the long term, or as a more convenient alternative to exercise-based approaches.

In curves over 20-25° with a moderate to high risk of progression, scoliosis bracing is typically considered and often will be used in conjunction with scoliosis specific exercise. As we discussed a the beginning of the month – bracing was shown to be effective in reducing the progression to the surgical threshold of 50° by the end of growth in 72% of cases compared to 48% of those who were purely observed. What is important to remember, is that those who wore the brace for more than 13 hours per day actually had a 90% success rate[5].

In curves 45-50°, conservative non-surgical treatment becomes more difficult. In older adolescents when a curve is less likely to rapidly progress, bracing may be used and combined with intensive scoliosis specific exercise. This may help to improve body aesthetics and reduce the curve size when surgery is not recommended.

In large curves in younger adolescents with a high risk of progression, or a high rate of curve development bracing may be used to slow curve development. This way surgery can be delayed until growth has finished so multiple surgeries are not required.

When curves are large and the risk of progression is high, surgery may be the only option. Surgery is recommended not purely on curve size, but also on curve location, future progression, loss of postural balance and when bracing has been unsuccessful.

 

What does Adolescent Scoliosis look like?

The below X-ray shows an example AIS case. It’s usually not possible to tell how severe scoliosis is without taking an X-ray, although external signs can suggest that the condition may be present. This is why regular screening is so important!

 

 

[1] Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis, N Engl J Med 2013; 369:1512-1521

[2] 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.

[3] Duval-Beaupere G: Pathogenic relationship between scoliosis and growth. In Scoliosis and Growth Edited by: Zorab P. Edinburgh, Scotland: Churchill Livingstone; 1971:58-64.

[4] Bunnell WP: The natural history of idiopathic scoliosis before skeletal maturity. Spine 1986, 11:773-776.

[5] Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis, N Engl J Med 2013; 369:1512-1521

Scoliosis awareness and the BrAIST study

Posted on May 27, 2021 by - Blog

Scoliosis awareness month is almost upon us, and as usual, we’d like to take the opportunity to draw attention not only to the condition but also to the importance of ongoing research. Scoliosis awareness month, for those who don’t know, takes place in June each year – with International Scoliosis Awareness Day on the last Saturday of each June.

While Scoliosis awareness day is a great opportunity for fund and awareness-raising events, National Scoliosis Awareness Month runs throughout June and aims, in particular, to highlight the growing need for education, early detection and awareness to the public about scoliosis and its prevalence within the community.

According to the scoliosis research society, the organisers of National Scoliosis Awareness Month, its official objectives are:

  • Using the results from the BrAIST Study, highlight the importance of early detection and the effectiveness of bracing as early, non-operative care.
  • Increase public awareness of scoliosis and related spinal conditions through educational and advocacy campaigns of local activities, and community events during the month of June.
  • Unite scoliosis patients, families, physicians, and clinicians in a collaborative partnership that educate, and advocate, for patient care, patient screening, patient privacy, and patient protection
  • Build networks of community collaborations and alliances to help sustain and grow the campaign[1]

 

It’s the BrAIST study – an important landmark for scoliosis research and treatment which we’d like to discuss today.

 

The BrAIST study

The BrAIST study, overseen by Dr Stuart Weinstein and published in 2013, was perhaps the most impactful study showing the efficacy of bracing in treating scoliosis cases.  In short, the study proved that bracing of adolescents with moderate scoliosis was an effective treatment in the reduction of the number of patients who advance to the need for surgery. In addition, a dose-response was found between the number of hours of brace wear and the success rate of bracing – which is to say, there’s a strong relationship between how long a brace is worn, and how effective the treatment is. Both are critical points when considering the value of scoliosis bracing as a whole.[2]

Unlike many of the smaller studies which inform our understanding of scoliosis and best practice in treating it, the BrAIST study was coordinated between several medical centres, and allowed the highest level of medical study, a randomized clinical trial, to be undertaken. To answer the question of whether bracing is effective in growing children and adolescents with curves.

During the study,  242 patients with curves between 20 – 40 degrees participated.  Patients in the bracing group were assigned to wear a brace 18 hours per day (a typical bracing prescription).  A special monitor was embedded in the brace to keep track of how long it was used per day.  Patients in the observation-only group received no additional treatment.  The endpoint of the study was “treatment failure” defined as progression of the scoliosis to 50 degrees or “treatment success” when skeletal maturity was reached without progression to 50 degrees.

Across the survey group, 72% of brace wearers avoided surgical recommendations, but only 48% of patients in the observational group did the same. Furthermore, however, it was also shown that patients who complied fully with their bracing instructions, and wore the brace for 13 hours or more was greater than 90%, showing both that the amount of time the brace is worn is very important and that the results we can expect with solid compliance are fantastic indeed. The study, therefore, provided strong evidence to the value of brace treatment for those adolescents at high risk of progression of surgery.

 

Why the BrAIST study matters.

The BrAIST study was notable due to its size – a large sample set, its nature – a fully randomised clinical trial and the credentials of its authors – a range of expert Doctors. The impact of the BrAIST study was therefore to provide solid evidence not only for non-surgical treatment but also against the “wait and see” attitude which has existed towards scoliosis for decades.

In the past, the value of a screening examination for scoliosis has been debated due to inconclusive evidence of the success of non-operative treatment for scoliosis – simply put, without strong evidence to show it’s possible to avoid surgery, why screen, and why bother?

Thanks to the BrAIST study, this is no longer true.  It shows that early screening and non-surgical treatment may reduce the number of patients who progress to surgery and, therefore, could serve as a potential cost saving for the health care system and of great benefit to patients. According to the study, Policy statements from professional organizations and governmental agencies regarding scoliosis screening in school programs and primary care settings will need to be reassessed in order to identify at-risk patients who will benefit from bracing for scoliosis[3].

And it’s this final point that highlights why scoliosis awareness month and the BrAIST study now matter more than ever – it’s 2021, and there’s no sign of the UK government even considering screening in schools for scoliosis, and, despite many organisations best efforts, the majority of people are still unaware of scoliosis, and it’s possible treatments.

That’s why this scoliosis awareness month, we invite you to help us spread the word – and, for your own knowledge, take just a moment to read the conclusions from the BrAIST study – you can find it here and read the abstract in about 3 minutes.

Over the next month, we’ll be posting articles about different kinds of scoliosis, how to spot them and what the treatment options could be – keep an eye out and help us to raise awareness throughout June!

 

[1] https://www.srs.org/patients-and-families/additional-scoliosis-resources/scoliosis-awareness-month

[2]     Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis, N Engl J Med 2013; 369:1512-1521

[3] Stuart L. Weinstein, M.D., Lori A. Dolan, Ph.D., James G. Wright, M.D., M.P.H., and Matthew B. Dobbs, M.D. Effects of Bracing in Adolescents with Idiopathic Scoliosis, N Engl J Med 2013; 369:1512-1521

Warning: this is NOT a Scoliosis Brace!

Posted on May 15, 2021 by - Blog

At the UK Scoliosis clinic, we specialise in Scoliosis Bracing – Scoliosis Bracing is a non-surgical treatment for scoliosis, which involves the detailed design and manufacture of a specialised, wearable brace which, over time, gently opposes the scoliotic curve in the spine, and works to guide it back towards a normal alignment.

Once upon a time (not too long ago), it was thought that scoliosis could not be stopped – that is to say, it was accepted that the curve would just continue to develop until, eventually, surgery was required to correct the deformity. Sadly, this approach is still recommended by some practitioners – who do not seem to be aware of the preventative and non-surgical corrective options available today.

The results achievable through modern bracing are however, impressive – to sample just a few studies, recent findings show that specialised scoliosis bracing when prescribed for high-risk patients, has been shown to prevent the need for surgery in most cases[1], that, overall, bracing is an effective treatment method for AIS cases, characterized by positive long-term outcomes[2] and even that conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis, with most patients reaching a complete curve correction[3]

What’s more, part-time bracing in adults significantly reduces progression of curvatures and improves the quality of life[4], and results suggest that bracing can even be “boosted” through complementary approaches – for example, specialised scoliosis physiotherapy (SEAS), when used in conjunction with bracing, has been shown to improve overall results[5]

There are many reasons to consider bracing as your primary treatment approach if you’re a scoliosis sufferer – however, in order to reap these benefits, it’s vital that you use a specialized, customized scoliosis brace.

 

This is not a scoliosis brace!

It cannot be stated clearly enough that the above studies all relate to medical-grade TSLO over corrective braces – that is to say, specially designed braces that are customized for the patient and their exact spinal condition. What’s more, these are braces that are fitted, designed, monitored and adjusted by Scoliosis professionals at every stage of the process.

As you may guess, this means braces are not cheap – even the most basic in this category cost over £1000 per brace  – this is still far cheaper than surgery and compares favourably with a course of exercise-based treatment – but it’s certainly not an inexpensive item.

It’s probably for this reason that every more products which market themselves as a “scoliosis brace” are appearing on Amazon, eBay and our other favourite shopping sites. It’s critical to realise that these offerings are not even close to the type of brace required for the results discussed above – and in some case, they may cause more harm than good.

These so-called “braces” are (see example right) are very often just posture supports, which may have some marginal benefit for those with a normal spine, but could, in fact, worsen a scoliosis case.

 

THIS is a scoliosis brace

A genuine scoliosis brace (see ScoliBrace right) is of rigid construction, which while still ergonomic, is able to gently apply pressure to the spine, in opposition to the curve. This means that gentle pressure is exerted in the direction the spine needs to correct, and only in this direction. This is the fundamental mechanism of a scoliosis brace- hence it should be obvious that a fabric-based “support” possesses none of the qualities required for scoliosis correction.

It is not the purpose of this article to single out any individual product, nor are we saying that “soft” supports have no use in spinal care – quite the opposite, however, if you are using a “Scoliosis brace” which you have not obtained through a specialist clinic, we would strongly advise you to discontinue use and seek a professional consultation.

 

 

 

[1] Weinstein et al DOI: 10.1056/NEJMoa1307337

[2] Aulissa et al,  https://doi.org/10.1186/s13013-017-0142-y

[3] Aulisa et al, DOI: 10.1186/1748-7161-9-3

[4] Palazzo et al, DOI: 10.1016/j.apmr.2016.05.019

[5] Negrini et al, DOI:10.1186/1471-2474-15-263

 

How is scoliosis treated in 2021?

Posted on May 1, 2021 by - Blog

Scoliosis treatment has come a long way since treatments for conditions first emerged at the start of the last century. Today there are more options for scoliosis sufferers than ever before, so a common question we often get is simply – “how should I treat scoliosis in 2021”? Over the next couple of articles, we’ll try to answer this as simply as possible.

Historically, it was thought that surgery was the only way to treat scoliosis – but today there are a number of non-surgical approaches which, when applied by a specialist scoliosis clinician, can treat scoliosis.

The two main treatment methodologies used are exercise-based approaches and bracing. Bracing is the most effective way to reduce a cobb angle (cobb angle is the measurement of scoliotic curve) and avoid surgery. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[i] Results vary by brace – but some studies have shown success rates with bracing as high as 100%.[ii]

Scoliosis specific exercise can be effective in treating smaller curves (generally below 20 degrees) where there is a lower risk of progression, but is probably best used in support of bracing, as a method to address muscular imbalances and postural problems which can often result from scoliosis.

Although the “wait and see” or “observation” approach to scoliosis management is now outdated, it is often still recommended by GP’s and is sadly still the favoured approach within the NHS. Unfortunately, the vast majority of scoliosis cases will progress, so it is better to seek advice from a scoliosis professional wherever possible.

 

This week, let’s compare the options which are most often known to patients – observation and bracing.

 

Observation (Wait and see)

Observation is not a treatment for scoliosis, it is simply the act of watching and waiting – however, scoliosis almost never resolves without treatment.

Research has demonstrated that Juvenile scoliosis greater than 30 degrees increases rapidly and presents a 100% prognosis for surgery. Curves from 21 to 30 degrees are more difficult to predict but can frequently end up requiring surgery, or at least causing significant disability.[iii]

Because observation is not a treatment, it most often leads to the patient requiring surgery. By contrast, today, through modern bracing technology, it has been demonstrated that conservative treatment with a brace is highly effective in treating juvenile idiopathic scoliosis. In one recent study of 113 patients, the vast majority achieved a complete curve correction and only 4.9% of patients needed surgery.[iv]

 

Bracing

Scoliosis braces are the most effective non-surgical method for reducing cobb angle[v] There are many different kinds of scoliosis brace and many work slightly differently, however broadly speaking braces can be classified as active correction braces (which aim to reduce scoliosis by guiding the spine back to correct posture) and passive braces (which aim to prevent scoliosis from developing any further by holding the spine in its current position).

Results vary by brace – but some studies have shown success rates with bracing as high as 100%.[vi]

Scoliosis bracing in children and adolescents is recommended when Cobb angles over 20° are observed and there is a risk of progression as the child grows. For cobb angles under 20°, bracing might still be a preferred treatment option, since (unlike exercise) no conscious effort is necessary from the wearer.

Night-time braces are also an attractive option for single curves not exceeding 35 degrees in magnitude.[vii]

 

(This article continues next week!)

 

 

 

[i] ‘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

[ii] De Giorgi S, Piazzolla A, Tafuri S, Borracci C, Martucci A, De Giorgi G. Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery? Eur Spine J.2013;22(6):S815–22, and Aulisa AG, Guzzanti V, Perisano C, Marzetti E, Falciglia F, Aulisa L.Treatment of lumbar curves in scoliotic adolescent females with progressive action short brace: a case series based on the Scoliosis Research Society Committee Criteria. Spine (Phila Pa 1976). 2012;37(13):E786-E791.

[iii] 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.

[iv] ‘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

[vi] De Giorgi S, Piazzolla A, Tafuri S, Borracci C, Martucci A, De Giorgi G. Chêneau brace for adolescent idiopathic scoliosis: long-term results. Can it prevent surgery? Eur Spine J.2013;22(6):S815–22, and Aulisa AG, Guzzanti V, Perisano C, Marzetti E, Falciglia F, Aulisa L.Treatment of lumbar curves in scoliotic adolescent females with progressive action short brace: a case series based on the Scoliosis Research Society Committee Criteria. Spine (Phila Pa 1976). 2012;37(13):E786-E791.

[vii] Grivas TB, Rodopoulos GI and Bardakos NV, ‘Biomechanical and clinical perspectives on nighttime bracing for adolescent idiopathic scoliosis‘ Stud Health Technol Inform. 2008;135:274-90.