Boston Bracing (Front)
Boston Bracing (Rear)
Most clinicians agree that if a Cobb angle reaches >20° in a skeletally immature patient, bracing should be initiated. The goal of bracing is to prevent progression of the scoliosis to an angle that requires surgery (Cobb angle of ≥50°) before skeletal maturity. At maturity, the risk of curve progression and risk of surgery decreases. All braces are made of similar thermoplastic material but designs vary. Every brace should aim to restore the normal contours and alignment of the spine by external forces. All braces have similar effectiveness in curve control. Two basic braces are commonly used: Boston or underarm brace which has the brace placed under the axilla and is used in controlling thoracic and lumbar curves. If there is a proximal thoracic curve which usually causes shoulder imbalance, a Milwaukee brace is used which includes a head and neck extension. All braces mainly function during the growth spurt. Some studies show that if patients wore braces >16 hours a day, the success of bracing may reach >90%. Hence, adequate tightness of the brace to exert external forces are important as well as the duration of brace wear.
Physical activities are important complements to brace wear. This improves patient posture and maintains physical health. However, there are no current conclusive evidence that suggests physical activities and scoliosis exercises improve Cobb angles.