For a Cobb angle reaches greater than 20° in a fast-growing, skeletally immature patient, bracing should be initiated. The menarchal status for girls is also considered in relation to their growth status.
The purpose of bracing is to control the spinal curve from progressing, and it will be worn until skeletal maturity. Brace-wear aims to prevent the curve size from reaching the angle that requires surgery before maturity, that is 50 degrees or more.
Brace is a custom-made orthosis made by the orthotist using thermoplastic material. The brace should be worn full-time for about 20 hours per day, as advised by the specialist. By using the external forces from the brace, it aims to restore the alignment and contour of the spine. It is important to understand that both adequate tightness of the brace to exert external forces and the brace-wear duration are needed to achieve the effect of bracing.
There are various designs of brace according to the curve type and needs. All braces have similar effectiveness in controlling the curve during the growing period of the patient. The common types of brace include underarm brace and Milwaukee brace.
- Underarm brace is indicated for thoracic and lumbar curves and the brace is placed under the axilla.
Appearance after putting on brace
- Milwaukee brace is indicated for proximal thoracic curve and it has a head and neck extension.
Photo Credit: Mr. V Yeng, Orthotist
Many factors affect or contribute to the success of brace treatment, including:
- Size and type of the curve, and its flexibility
- Skeletal maturity status
- Correct fitting of the brace
- Brace compliance by the patient
In Duchess of Kent Children’s Hospital, a well-structured, multidisciplinary approach is adopted once the brace is prescribed by the specialist. The patient is advised to see the orthotists, physiotherapists, clinical psychologist and medical social worker for various needs.