Concepts of Bracing Adolescent Idiopathic Scoliosis

David Speers, CPO,LPO

Scheck and Siress

Scoliosiscoronal plane deformity (primarily)

1) Congenital – present at birth due to anomalies in the vertebrae (hemi-vertebrae)

2) Neuromuscular – deformity due to weakness or paralysis (cerebral palsy, spina bifida)

3) Idiopathic – (infantile, juvenile, adolescent) – unknown cause

When to brace(Scoliosis Research Society Guidelines)

• Skeletally Immature Patients (Risser 0,1,2)

• Curves with the magnitude of 25-40 degrees

• Curves over 20 degrees with documented progression

A Brief Review of Natural History (untreated adolescent

idiopathic scoliosis)….

Lonstein :1984 JBJS

Risk of Progression(Percent)

RISSER SIGN 5-19° 20-29° 30° 0,1 22% 68% 90+%

2,3,4 1.6% 23% 50-70%

Assessing skeletal maturity:Risser Sign

Bracing Concepts for scoliosis

• TLSO (thoraco-lumbar-sacral orthosis)

• Three point pressure system to correct the curve(s)

• Daytime,night time, both

• Anterior or posterior open designs

Expectations for scoliosis bracing

• Brace to prevent progression of the scoliotic curve(s) during growth

• Curve will be corrected in the brace (40-50% daytime, 90-100% night time brace)

• Curve will be present when brace is removed

Out of Brace vs. In Brace

Out of Brace vs. In Brace

Many styles of scoliosis tlso braces

Daytime tlso concepts

• 3 point pressure system

• 16 – 23 hour wear

• Can be worn at night as well

• Made from CAD measurements or molding

Essential componentsDaytime tlso

ThoracicPadLumbar

Pad

AxillaryPad

Trochanteric Extension

Night time tlso concepts

• “over correction” with lower wear time

• 90 – 100% correction achieved

• Providence and Charleston styles

• Single curves• Increased compliance

Night time tlso

Providence TLSO Charleston TLSO

“bending brace”

When to discontinue(skeletal maturity)

• Look for plateau in height

• Risser sign (4 or 5)

• Menstrual cycle: 1.5 – 2 years after start

• Tri radiate cartilage in hips should be closed

• Check height of parents if possible

• Girls mature sooner than boys

Wear time monitors(temperature)

Tidbit I-button (Maxim)

Wear time monitors

• Placed inside of the brace

• Monitors average hours worn

• Displays 24 hour wearing profile

• Graphs daily hourly use

• Accurately shows how the brace is being worn

Thank you