Adolescent idiopathic scoliosis (AIS) refers to a condition of spinal curvature and deformity in children and teens that has no apparent cause.
The word “idiopathic” means “cause unknown”. Another word for the underlying cause of a disease or condition is etiology. There are many theories about the etiology of adolescent idiopathic scoliosis (AIS) but no clear single cause. Most experts consider AIS to have multiple linked causes including genetics, environment and lifestyle, and nervous system dysfunction with biologic and hormonal influences.
Treatment specific to the cause is usually the most effective approach. Without that, the symptoms become the focus and that’s where bracing comes in. The idea is that by placing the spine in an upright position, the forces causing the curvature can be stopped — or at least slowed.
You are aware that the results are variable. No one has been very successful predicting who will do well and by how much. When surgeons are asked why they use bracing without convincing evidence that it always works, there is agreement that the chance to reduce the risk of needing surgery is worth the effort. And in young children with adolescent idiopathic scoliosis, studies show 25 per cent of the patients do avoid surgery because of the bracing.
Once the decision has been made to use bracing, the next natural question is: which one or what kind? The brace maker (called an orthotist because orthosis is the more modern name for brace) helps guide the decision. This is done in communication with the parent, surgeon, and physical therapist. A team approach is best when looking at the whole child and taking into consideration spine, surrounding soft tissues, general health, and activity level.
Some of the more commonly used braces for adolescent idiopathic scoliosis include the Boston brace, the Wilmington brace, the SpineCor brace, the Milwaukee brace, the Triac brace, the Sforzesco brace, the Charleston brace, the Providence brace, and the Cheneau brace.
Some of these braces are intended to derotate the vertebrae. Others force the spine to bend in the opposite direction of the developing curve. The Charleston bending orthosis provides this type of overcorrection and is worn only at night.
Most of today’s braces are made of plastic with either metal uprights or velcro or canvas straps to hold them in place. With the exception of the braces intended only for night-use, most braces used for adolescent idiopathic scoliosis are designed for use 23 of each 24 hours. The brace is removed only for bathing, swimming, and dressing.
If the surgeon who gave you the prescription didn’t tell you where to go, call the office and ask for a recommendation. The orthotist will guide you through the process from there. Sometimes clinics are held on a specific day each week or month so that the team can all be assembled together to evaluate, discuss, and plan the best approach for each child. In some cases, the orthotist will begin the process and then team evaluations take place later.