Concepts of Bracing Adolescent Idiopathic Scoliosis David Speers, CPO,LPO Scheck and Siress

Scoliosis coronal plane deformity (primarily) Congenital – present at birth due to anomalies in the vertebrae (hemi-vertebrae) Neuromuscular – deformity due to weakness or paralysis (cerebral palsy, spina bifida) 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 5-19° 20-29° 30° 0,1 22% 68% 90+% 2,3,4 1.6% 23% 50-70%

Assessing skeletal maturity: Risser Sign Peak growth velocity is likely in Risser 0 or 1 w/ open triradiate cartilage 5

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 (40-50% 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 Art and science (skill and experience of the treating Orthotist) come together—no one system is really “best” All can work some are better than others given certain criteria 10

Daytime tlso concepts 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 Thoracic Pad Lumbar Pad Trochanteric Extension

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) 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

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