Your child is in the middle of treatment for adolescent scoliosis. It is hard work for both the parents and the child or teen herself (sometimes himself). Between physical therapy, bracing of different types or even spinal surgery in extreme or sometimes unnecessary cases, it would be comforting to know that in the long-term, improvement and rectification of the spinal curvature will be permanent.

The right time for brace treatment is during the growth spurts of your child. We know that brace treatment effectively curtails curvature progression, but questions remain about long term stabilization into adulthood and beyond. There is still some controversy of scoliosis bracing among certain homeopathic practitioners. In this article we will touch on both, the short term and long-term effectiveness of scoliosis bracing for children and adolescent sufferers of adolescent idiopathic scoliosis.

Let us look at an actual real-life case of a girl with adolescent idiopathic scoliosis. The case we are studying is the treatment of an eleven-year-old girl. (For ease of explanation we will call this girl Lisa, since privacy prevented publication of her name). Lisa’s treatment was started when she turned eleven and weaning from the brace began when she was fifteen, since no more residual growth was anticipated by the scoliosis experts and her doctor.

When Lisa began treatment with the Rigo-Chêneau brace her Cobb angle measured thirty- eight degrees. After two years of bracing, the Cobb angle was reduced to nineteen degrees. The Cobb angle did increase slightly to fourteen degrees at weaning. When Lisa turned twenty-one, five and a half years after brace weaning, there was no change in the Cobb angle, which steadied at nineteen degrees. Lisa and her happy parents were extremely satisfied with the outcome of treatment and Lisa has full functionality in every way.

Why does the idea that bracing does not work remain when so much research and case histories show that the opposite is true? There is a practical side to this claim for practitioners who are not medical doctors, for example chiropractors and nutritional experts to boost and sell their treatment plans. Their claims may have validity for small Cobb curves of less than twenty-five percent. Especially for actively growing children and teens, anyone with a Cobb curve above twenty-five percent, treatment without a brace is quite risky and even dangerous having permanent ramifications as they turn into adults. In fact, there was a major well-known study called, The BrAIST study which ended prematurely because of ethical reasons. Why allow a child with scoliosis to be treated with a questionable non-brace treatment and put them into long term jeopardy when the data was clearly showing that there was a great likelihood of them suffering permanent irreversible damage?

Chiropractors such as Dr. Jordan Axe, use muscle strengthening techniques and soft braces. These ideas in themselves sound appealing but only if the Cobb curvature is negligible or under twenty-five degrees. However, with a substantial curve, muscle firming and strengthening is not going to do it because it is not the muscles that are the problem but the bone structure of the back.  Let us compare it to a bone fracture. For example, if a person can use a soft cast for a minor fracture that is great but for other more serious breaks a hard cast must be worn. Similarly, a person who has a major curvature of the spine needs a hard brace to realign and fix the bone structure itself. Dr. Axe claims correctness is lost after the patient stops wearing the brace sometimes requiring surgery afterwards. When good bracing practices are utilized reliable scientific evidence shows that these claims are false.

Dr. Stuart Weinstein’s, 2013 BrAIST study, is one of the most important conclusive studies of the benefits of scoliosis bracing for adolescent idiopathic scoliosis. Nine additional studies met the Scoliosis Research Society’s criteria confirming that bracing is the most successful treatment available. In fact, each of these studies confirmed that the average success rate of the treatment is 85.4%. As of last year, 2019, it was confirmed by the above society that bracing is successful in treating most patients suffering from adolescent idiopathic scoliosis.

When Maddie Houser, a ten-year old youngster from North Liberty, Iowa was given a scoliosis diagnosis, her mom Becky wanted to avoid surgery at all costs, so she volunteered for her daughter to be part of Dr. Weinstein’s study. Becky had her own experience with scoliosis surgery herself. Becky spent three weeks in the hospital and nine months in an upper body cast when she had her surgery thirty years earlier.

At thirteen years of age, Maddie, Becky’s daughter was given the good news that she no longer needed her scoliosis brace since her growth spurts had stopped and she was stable at a twenty-eight degree curvature.

Dr .Weinstein presented his findings at the forty-eighth Annual Meeting of the Scoliosis Research Society, in Lyon, France. At the same time, he published the results of his study online in The New England Journal of Medicine. Several medical facilities worked simultaneously to conduct a medical study of the highest level to answer the question of how effective bracing was in children and adolescents. Two-hundred-forty-two patients at twenty-five sites across America and Canada were included in Dr. Weinstein’s study. The children, who were still growing, ranged from ten years to fifteen years of age. Their Cobb degrees ranged from twenty to forty degrees.

A special monitor was placed inside the brace of the patients in the bracing group to keep track of how long the brace was worn each day. The prescription for this study was eighteen hours. (The length of time has been increased recently to up to twenty-three hours in many scoliosis centers.) There was a control group which did not receive bracing. Of the brace wearing group, seventy-two percent of the wearers avoided any type of surgery while over fifty percent in the control group required corrective surgery. Increased wearing time of thirteen hours and more increased the success rate by ninety percent. This study concluded that not only was brace wearing crucial to recovery but the amount of time the brace is worn is so important. Strong evidence of the value of brace treatment was especially valuable to those adolescents who were at high risk for surgery requirements.

An article in the New York Times concluded that wearing of a scoliosis brace will slow the progression of the idiopathic adolescent scoliosis and help avoid surgery. As stated above, the trial was stopped earlier than originally planned because the clarity of the bracing was so pronounced.

 A 2017 study by Angelo Aulisa followed patients for fifteen to twenty years after completion of scoliosis bracing. Over a twenty-one-year period, two-hundred and nine adolescents with scoliosis were in the Aulisa study.  All curves (within three degrees increase) stayed around the same even after fifteen years of treatment completion. What the curve was before made little difference, if the curve was smaller than thirty degrees or larger than thirty degrees before beginning brace treatment.

Long term studies have been conducted for the last forty to fifty years stating that when left untreated scoliosis can worsen according to the size of the curve. Even after the patient stops growing the deterioration will continue especially when the curve is above fifty degrees. Studies following patients even twenty years following spine correction surgery with screws, rods and bone fusion have found that curves can continue to increase.

Conclusion

Finally removing a brace that was worn by your child or adolescent for several years is a crowning moment to be cherished. Looking at the results and improvement is a happy moment for sure for both parents and child.  Celebration is certainly in order with a trip to the mall for a new fashion wardrobe and a peaceful and undisturbed night’s sleep. A parent would be even happier if they could be assured that their child’s progress and the greatly lessened Cobb degree angle that was measured at brace removal would be permanent. From major studies conducted, it seems that the answer is, yes. Even if the Cobb angle increases slightly over the years of adulthood, the patient’s quality of life does not decrease. Learning the skills of standing straight along with exercising regularly, the adult scoliosis patient has a great chance of never going back to the humpy uneven look of their childhood.

As bracing becomes accepted each year more and more as the optimum treatment of adolescent idiopathic scoliosis, we will see more studies of its treatment successes. There are so many different types of braces today each one specifically engineered for the patient’s optimal valuable therapy. Looking to the future is always beneficial in any type of temporary therapy, whether, psychological, physical, or even dieting. Seeing actual case histories of patients similar to your own child will help both you and your child look to a winning future and seeing the brace in the closet, basement or garage will be a reminder of your child’s victory and for your perseverance as parents to keep your child positive in reaching their goal.