Bracing has been used with some success in the treatment of scoliosis. This is the first long-term study of part-time bracing in children with juvenile idiopathic scoliosis (JIS). JIS occurs before the start of puberty. Most children are affected between the ages of three and 10.
Studies have shown that there are negative effects on teenagers’ personality and self-esteem who are treated full-time with bracing. JIS especially requires a long period of bracing as the child is growing. Finding a part-time bracing program that would work for JIS may help prevent progression of the curve during growth spurts.
The Charleston nighttime bending brace was used with children who had JIS curves greater than 20 degrees. The Charleston brace is molded to the patient while they are bent to the side. This applies pressure to bend the child against the curve to correct it.
The braces in this study were all made and fitted by the same orthotist. Everyone wore the brace for at least eight hours during each 24-hour period. The brace was worn at night while they slept.
Measurements of the curves were taken before, during, and after bracing. Various X-ray views were included. Standing X-rays were taken out of the brace. Best correction in the brace was also done in the supine position (lying on the back).
The children were divided into three groups based on the size of their curve before and after bracing. Group one was labeled the success group. Their curves stayed the same, got better, or progressed five degrees or less.
Group two showed worsening of their major curve. The curve stabilized when their bones stopped growing. Surgery was not needed. Group three had continued worsening of their curves until the curve measured more than 45 degrees. Surgery was indicated for this group.
At the end of the study, slightly more than half the children had a successful result. Children were more likely to succeed who had a single (rather than double) curve with good correction in the brace.
The authors report that the small number of children in this study make it impossible to know if some curves respond better to bracing than others — or to find any consistent factors linked with brace failure. Future larger studies using bracing for JIS are needed.