Bracing is recommended for scoliosis in adolescents with curvatures of 25 degrees and over. The decision to brace or not is an easy one in an adolescent who has not yet reached skeletal maturity. What is difficult is determining which brace to use. There has been little change in traditional bracing methods in the US in many years. The most commonly used brace is a TLSO or thoracolumbosarcal orthotic. This is a hard plastic brace that is custom made and envelopes the torso. The most commonly prescribed TLSO in the US is the Boston brace. Its purpose is to hold you in your usual posture with the intention of slowing curve progression. Problems associated with this brace are a decrease in pulmonary volume and trunk strength.
If an adolescent has a large upper thoracic compensatory curvature, a brace that has a component that stabilizes the head and neck while providing traction may be recommended. This brace is commonly known as the Milwakee Brace. In addition to the problems associated with a TLSO, compliance with this brace is low because of discomfort and difficulty hiding under clothing.
Soft braces are sometimes recommended. The idea of a soft elastic brace that can be worn but not seen under the clothes is very attractive for anyone. However, these braces are stabilized over the shoulders and under the pelvis, which increases axial compression.
A Modified TLSO braces that provide 3 dimensional corrections of the curves is also available. This is a hard plastic brace that provides up to 50% correction of not only the lateral curvature but also of the rotational component that causes rib rotation and lumbar prominences. It provides pressure at the apices of the curve, but also has openings at the sites of the concavities. This is helpful not only for comfort and temperature control, but also allows for specific rotational breathing exercises to counter-rotate the spine. By reducing the pressure on the wedge shaped vertebrae through three-dimensional correction, we give the spine to opportunity to correct as a child grows. Our preferred provider for 3 dimensional bracing is Grant Wood at Align Clinic in San Mateo, California.