April 18, 2017

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, there are kids who are finding that wearing a scoliosis brace doesn’t have to be a horrible experience. When it comes to scoliosis bracing, nighttime bracing for mild scoliosis allows for a less stressful experience and aims to prevent progression. When mild scoliosis is at risk of being progressive, nighttime bracing in the Cheneau Gensingen brace offers several benefits.

nighttime bracing, cheneau brace
Spinal correction with nighttime scoliosis brace

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 for PT for her back pain, but to address her mild scoliosis her mom wanted her to participate in our Schroth program. For a time, the curves remained stable, measuring 14º thoracic and 16º lumbar in her June 2016 x-ray. However, as kids tend to do, she had 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 (less than a 5º change). Although hers wasn’t a sizable progression, it certainly wasn’t going in the direction we like to see. Dr. Marc felt her progression risk was considerable due to her spine being quite unbalanced. He recommended nighttime bracing sooner rather than later since this patient also has a family history of scoliosis. Also, despite her rapid growth spurt, she was still quite petite and premenarcheal. In addition, her x-ray demonstrated she was still a Risser stage 0 – meaning she still had a lot of potential for growth.

Shortly after, we scanned and fitted her for a Gensingen brace® for nighttime wear. Since our patient is from the Boston area, we recommended she wait four weeks after her final brace fitting to get an in-brace x-ray. The reason for this is so the spine has the chance to adjust to the brace.

As is clear to see 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! You should expect your child’s scoliosis brace to deliver a visually noticeable in-brace correction. This is necessary to help manage the curvature. We find another benefit of a good in-brace correction is that it serves as great motivation for kids who need a scoliosis brace, even some of the reluctant ones. When the in-brace x-ray shows an obvious correction it can be a lightbulb moment for some kids. This patient reports wearing her Gensingen brace faithfully each night.

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 fitted with her brace at an 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 tag line is “don’t wait and see!”


https://www.ncbi.nlm.nih.gov/pubmed/16093941

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