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

2. 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

3. When to brace (Scoliosis Research Society Guidelines)
Skeletally Immature Patients (Risser 0,1,2)
Curves with the magnitude of degrees
Curves over 20 degrees with documented progression

4. A Brief Review of Natural History (untreated adolescent idiopathic scoliosis)….
Lonstein :1984 JBJS
Risk of Progression(Percent)
RISSER SIGN ° ° °
0, % % %
2,3, % % %

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

6. 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

7. 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, % night time brace)
Curve will be present when brace is removed

8. Out of Brace vs. In Brace

9. Out of Brace vs. In Brace

10. 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

11. Daytime tlso concepts 3 point pressure system 16 – 23 hour wear
Can be worn at night as well
Made from CAD measurements or molding

12. Essential components Daytime tlso
Axillary
Pad
Thoracic
Pad
Lumbar
Pad
Trochanteric
Extension

13. Night time tlso concepts
“over correction” with lower wear time
90 – 100% correction achieved
Providence and Charleston styles
Single curves
Increased compliance

14. Night time tlso
Providence TLSO
Charleston TLSO
“bending brace”

15. 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

16. Wear time monitors (temperature)
Tidbit
I-button (Maxim)

17. 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

18. Thank you