Wearing a scoliosis brace isn’t easy for kids; however, it is sometimes the inconvenient truth for kids with adolescent idiopathic scoliosis (AIS). 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, the Chêneau Gensingen brace (nighttime version) offers several benefits.
We recently fitted a girl, now nearly thirteen and a half years old, 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 in Boston referred her for PT for her back pain but to address her mild scoliosis, her mom wanted her to participate in our “limited” 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 since it’s less than a 5º change. Although it 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 so he recommended bracing sooner rather than later. This patient also has a family history of scoliosis and despite her rapid growth spurt, she is 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 the Gensingen brace® (complete brace measures and fittings can take place within four days when need be). 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. This is so the spine has the chance to adjust to the brace. A few weeks later, the patient and her mom came in the review her x-ray results. We were very happy with her in-brace correction and so was she. In fact, when this girl saw the image, her face lit up–and her mom’s did too! This is the benefit of visually noticeable in-brace corrections: it serves as motivation for kids who need to wear a brace, even some of the especially 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!”