Concepts of Bracing Adolescent
Idiopathic Scoliosis
David Speers, CPO,LPO
Scheck and Siress
Scoliosis
coronal plane deformity (primarily)
1) Congenital – present at birth due to
anomalies in the vertebrae (hemivertebrae)
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
30°
0,1
2,3,4
5-19°
22%
1.6%
20-29°
68%
23%
90+%
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 (4050% 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
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•
•
•
3 point pressure system
16 – 23 hour wear
Can be worn at night as well
Made from CAD measurements or molding
Essential components
Daytime tlso
Axillary
Pad
Lumbar
Pad
Trochanteric
Extension
Thoracic
Pad
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)
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•
•
•
•
•
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