Casting and Bracing to Treat Scoliosis

Patients with Infantile Idiopathic Scoliosis are usually in this treatment for up to 2 years.  

The type of casting we use to manage scoliosis is Mehta casting. A Mehta cast is a body cast that is around the torso. There is a cut out area for the belly and a relief cut out on the side or back to achieve the corrective forces that are needed to guide straighter growth. 

Your provider may recommend a spinal brace in order to help manage your curve.

It is important to remember that the purpose of the brace is to slow or stop the progression of the curve. Unfortunately, in most cases, wearing a brace cannot improve or straighten a curve. In some cases, however, it can improve some of the body asymmetries to improve cosmetic appearance.  

A brace is only prescribed for children and teens who are still growing.  Once the majority of growing is done, your provider will slowly reduce the amount of time that the brace is worn until you are done wearing it completely.  You will not have to wear a spine brace for the rest of your life. 

How successful the brace is at managing your curve is directly related to how often you wear it. The brace works by guiding the spine to grow straight. Because you are growing all the time, the more you are in the brace, the more time this growth is being guided.

There are three types of braces that are most commonly used to treat idiopathic scoliosis: 

Full TIme Thoraco-Lumbo-Sacral Orthosis (TLSO):

This type of brace is made of plastic and foam and extends from under your armpits down to just below your hips.  It wraps around your body and has areas built inside it in order to apply pressure to your curve(s).  It is prescribed for thoracic and lumbar curves that are the most at risk of progressing and is usually worn “full-time”, or a minimum of 18 hours per day. This type of brace is considered the “gold standard” for managing idiopathic scoliosis, which means that we have the most evidence that shows that TLSO treatment works at stopping or slowing curve progression and preventing surgery as long as it’s worn as prescribed.   

Night Time/ Hypercorrective TLSO: 

This type of brace is only worn at night.  It’s made of plastic and foam and extends from your armpits down to the bottom of your hips, usually lower on one side to about mid-thigh. It wraps around your body and has “hyper-corrective” areas built inside it in order to apply pressure to your curve(s).  A Night Time TLSO is able to push on your curves more aggressively than a standard TLSO because it’s only worn in a lying down position when your spine is more flexible and gravity is not influencing your spine. If curves continue to progress even with the Night-Time TLSO your provider may consider adding a full-time TLSO to your treatment plan. 

Cervico-Thoraco-Lumbo-Sacral Orthosis (CTLSO):
This type of brace is rarely indicated and is used to treat curves that are high in the spine. It is made of plastic and extends from your neck to the bottom of your hips. A CTLSO is usually worn “full time”, or a minimum of 18 hours per day.  

Getting Your Brace 

If your provider recommends a brace to manage and treat your scoliosis, you’ll visit one of our spine orthotists in Gillette’s Orthotics, Prosthetics and Seating Department, or OPS. Most braces for scoliosis are custom-fabricated, meaning that they are made special just for your body and your particular curve pattern.  You will be scheduled for an evaluation appointment and then a fitting appointment to get your brace.  Once you have your brace, you will have regular follow up appointments with your orthotist to be sure that it’s fitting correctly and comfortably as you grow. 

Evaluation for a Brace

This appointment is either a 1 or 2-hour appointment.  During the evaluation, your spine orthotist will evaluate your back, take measurements and either take a plaster cast or a digital scan of your torso.  At this appointment, you’ll be able to choose a pattern and/or a decal for your brace to make it unique and special for you. 

Fitting Your Brace

This appointment lasts for 2-6 hours, depending upon the type of brace you are getting and also how complex it is.  You’ll try on your brace several times during the appointment and the orthotist will trim plastic and add pads as needed.  You’ll practice putting the brace on and wear it for a while to be sure it’s comfortable before you take it home. Your orthotist will give you information about taking care of your brace, taking care of your skin and how you should get used to wearing your new brace.  

Follow Up

After you get your brace, you may need to return to see your orthotist 2-3 weeks later to make sure it’s pushing appropriately on your curves. In addition, every time you see your spine provider, you should be scheduled to see your orthotist as well to do a check of your brace.  If at any time, you have concerns or questions about your brace or how it’s fitting, you can always call your orthotist and come in for adjustments if needed.    

Your spinal brace must be worn according to your provider’s instructions to achieve the best results. If a spine brace isn’t worn, it will not help your scoliosis. 

Wearing a spinal brace can be challenging for many reasons. We understand that wearing a spine brace is not an easy thing to do. It is important that you feel good about yourself and, at the same time, accept wearing the brace. Your scoliosis is one small piece of who you are. We want you to know that your spine care team is more concerned with your overall health than your spine alone. If treatment with a brace results in negative feelings, we encourage you to share that with your spine care team. It is important that we work as a team to provide the best overall outcome for you.   

Here are some suggestions that may help: 

• Talk about your brace with your friends and family. Friends can be a really great source of support, so include them early on in your treatment. Feel free to bring a friend along to your fitting appointment. 
• Remember that you won’t have to wear your spine brace forever. Braces only work on patients who are still growing. 
• Find types of clothing to wear over your brace that will make you feel good about your body. 
• Focus on your positive qualities and talents, not the spine brace. 
• Tell your school nurse that you wear a brace. If you ever need assistance with your brace at school, the nurse will be there to help you.