Scoliosis brace treatment objectives vary significantly from patient to patient and may include the following:
- Provide curve correction
- Prevent curve progression
- Slow curve progression to avoid or delay surgery or reduce the extent of surgery
- Postural improvement
Before your first appointment at Hampshire Orthotics for assessment for scoliosis bracing you need to provide:
- A diagnosis from a spinal consultant (because not all types of scoliosis are suitable for a brace and may require medical treatment instead). The consultant should be an orthopaedic spinal surgeon working in the NHS (via referral from your GP) or private. Private spinal consultants in Hampshire are Mr Chris Dare at the Wessex Nuffield, Southampton. 02380 258432 (non neuromuscular scoliosis children only)
- Recent X-rays of the spine (less than 3 months old)
X-rays
Two X-rays are needed: “full spine PA” and “full spine lateral”, T1 to sacrum, including iliac crests and the width to the rib margins.
The X-ray must be taken in standing if possible.
X-rays can be done free of charge at your local NHS hospital by referral from your NHS spinal consultant. Alternatively, the X-rays can be taken at a private hospital. For a lower dose of radiation, the EOS scanner. https://www.alliancemedical.co.uk/modalities/eos-ct is an option. The nearest location for EOS scans is London (Harley St). Please let Lucy know if you would like an EOS scan so that a referral form can be sent.
The X-rays or EOS scans will be analysed before your first assessment appointment.
What to expect at the initial appointment
At the initial appointment your child will have a clinical assessment. For this she/he will need to undress down to underwear (standard bra or sports type for females). The skin will be marked using a make-up pencil and photos will be taken. Your child’s weight and standing and sitting height will be measured.
Your child’s leg lengths will be assessed, and she/he may be supplied with a shoe lift as part of the treatment.
If a scoliosis brace treatment is thought to be appropriate, the different brace options suitable for your child’s spine will be discussed with you. Your child will then be measured for the brace in a relaxed standing position and/or lying down position. Scans will usually be taken using a 3D scanner.
Brace fitting appointment (visit 2)
1-2 weeks later, the brace will be fitted, and you and your child will be shown how to correctly apply it. Instructions will be given about the weaning-in programme.
Exercise programme
Scoliosis exercises are an optional recommendation. They will help to build up muscle strength to improve your child’s posture. Details of the nearest accredited scoliosis exercise provider in your area will be provided to you.
Follow up appointments and X-rays/EOS scans
The first review appointment (visit 3) will take place after your child has been wearing the brace for about 1 month. The brace will be checked and adjusted if required. Your child will then need another X-ray or EOS scan (full spine PA) within 6 weeks of the brace fitting. This will be in brace and with the shoe raise (if supplied). This is to evaluate the early effects of treatment and any structural instability.
Your child will then have brace reviews every 3 months.
Your orthopaedic spinal consultant will review your child with out of brace X-rays/EOS scans (full spine PA) every 6 months to assess curve progression. The brace should be removed 2 to 4 hours before this X-ray/EOS.
Towards the end of treatment, there may an additional X-ray/EOS of the left wrist to determine skeletal maturity.
Frequency of brace wearing
Usually brace wear is for 20 hours per day for optimal outcomes. It may be removed for sports, dance and physical therapy exercises if prescribed, with these activities taking place in the allowable 4 hours out of brace. In some cases, a night brace is prescribed which is only worn for 10-12 hours per day.
How long does the brace have to be used and how long does a brace last?
Brace use will continue in most cases until skeletal maturity when the spine has reached its full growth. Brace replacement is approximately one per year depending on growth of your child.