Wearing a scoliosis brace isn’t easy for kids; however, it is often the wisest approach for kids with idiopathic scoliosis (AIS) diagnosed early in adolescence. Fortunately, some kids are finding that wearing a scoliosis brace doesn’t have to be a horrible experience when the process starts sooner rather than later. Nighttime bracing for mild scoliosis allows for a less stressful experience and aims to prevent progression or reversing the curvature to some extent rather than waiting too long to address scoliosis. When mild scoliosis is at risk of being progressive, we offer nighttime bracing in a Chêneau style brace which can offer several benefits.
The girl whose x-ray is shown above was nearly thirteen and a half years old at the time we fit her for a nighttime brace. This girl initially presented to our office in February 2016. At that time, her Cobb angles measured 12º thoracic and 19º lumbar and she was experiencing back pain of undetermined origin. Her doctor from Children’s Hospital, Boston, referred her to a PT for her back pain, but her mom had other ideas. She wanted her to participate in our Schroth program so we could address her daughter’s mild scoliosis. For a time, the girl’s curves did remain stable, measuring 14º thoracic and 16º lumbar in her June 2016 x-ray. However, as kids tend to do, she experienced a growth spurt of 1” (2.54cm) in the latter half of 2016.
Fast forward to February 2017, our patient’s next x-ray showed thoracic and lumbar curves of 18º and 20º. Technically, as scoliosis goes, this is considered unchanged (there is a 5º margin of error when measuring Cobb angles on a scoliosis x-ray). Although her scoliosis progression wasn’t sizable, her spinal curves certainly were not going in the direction we like to see.
Dr. Marc also felt that her progression risk was considerable due to her spine being quite unbalanced. He recommended nighttime bracing, sooner rather than later since this patient has a family history of scoliosis. Also, despite her rapid growth spurt, she was still quite petite and premenarchal. In addition, her x-ray showed she was still a Risser stage 0 – meaning she still had significant growth potential.
Soon after, she was measured and fitted with her scoliosis brace. She was instructed to use the brace for nighttime wear only since her curves were mild. (When you use a Chêneau style brace for nighttime wear, if things aren’t going as planned then the brace can be used for additional hours – the brace is different than nighttime braces that bend the spine so that the patient is unable to walk in them). This girl is a Boston area patient. We recommended she wait about four weeks to have her in-brace x-ray. We do this for local patients so the spine has the chance to adapt to the brace.
We were very happy with her in-brace correction! When this patient saw the image, her face lit up–and her mom’s did too! When your child has some growth potential, you should expect your child’s scoliosis brace to deliver a visually noticeable in-brace correction. This is necessary to help manage the curvature. Another benefit of having a very good in-brace correction is that it serves as great motivation for kids who need a wear a scoliosis brace and as we’ve seen can even convince some of the reluctant ones to be fully compliant when it comes to wearing a scoliosis brace. When the in-brace x-ray shows an obvious correction, it is a lightbulb moment for many kids.
While she and her mom were in our office to see that x-ray, someone on our team commented that this patient was looking a little taller. So, we measured and discovered that within five weeks she had grown another 2 cm. To that end, it looks like she was fit with her brace at the opportune time. According to a recent study, “progression is most notable with a growth velocity of >or=2 cm/year, at ages between 9 and 13 years, bone ages between 9 and 14 years, Risser signs 0-1, and between 0.5-2 years before menarche.”¹
Managing scoliosis can be a tricky business. What’s important to know is that an immature spine is a more malleable spine and a more malleable spine is more amenable to the right conservative treatments. Making sure kids get the right conservative treatment at the right time is essential. It’s the reason why our tagline is “don’t wait and see!”
https://www.ncbi.nlm.nih.gov/pubmed/16093941
Updated: Feb 3, 2025
