Question:Do the night-time only braces work as well as the daytime braces for scoliosis?
Answer:There are a wide variety of braces used to treat scoliosis or curvature of the spine. Studies show that the type and location of the curve(s) dictates which kind of brace to use.
When braces were first used to treat scoliosis, the Milwaukee brace was worn 23 hours a day. This type of brace goes from neck to sacrum with metal uprights to hold the body straight.
It has a pelvic girdle, two posterior uprights, one anterior upright, and a ring around the base of the skull that also supports the lower jaw. It was originally made of leather and metal. It has been revised now and is constructed out of rigid plastic with metal uprights. Straps attached to the frame are used to apply corrective forces.
A brace that starts under the arm and does not include the neck can be used for curves lower down in the thoracic spine. This type of brace is called a thoracolumbosacral orthosis or TLSO. Both the Milwaukee and the TLSO types of braces are usually worn 22 hours each day. They are removed only for a brief period to shower, change clothes, and participate in certain (noncontact) sports.
The nighttime braces, such as the Providence or the Charleston are worn at least eight to 10 hours each night while the child is sleeping. The way in which these two braces work is different.
The Providence pushes the curve toward the midline of the spine. The curve may even be overcorrected at first. The Charleston bending brace works by bending the spine in the opposite direction of the curve. Studies show the Providence brace works best but it must be used early when the curve is 25 to 35 degrees.
Some experts suspect the Providence brace works better because children are more likely to put it on and keep it on for the required number of hours. It's likely that not wearing the Milwaukee brace or the TLSO has resulted in poor outcomes.Joseph A. Janicki, MD, et al. A Comparison of the Thoracolumbosacral Orthoses and Providence Orthosis in the Treatment of Adolescent Idiopathic Scoliosis. InJournal of Pediatric Orthopaedics. June 2007. Vol. 27. No. 4. Pp. 369-374.
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