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Boston Brace System for Parents Guide
For the treatment of Adolescent Idiopathic Scoliosis and other forms of scoliosis. This novel device was created by our founder, Bill Miller, and a number of the top specialists at Childrenˇ¦s Hospital Boston dating back to 1975. Amazingly, this bracing system is still considered the Gold Standard of scoliosis treatment. Our results are used as a measuring stick for the industry. Please see some of our recent results.
What Is Scoliosis?
Scoliosis is a musculoskeletal disorder in which there is a sideways (lateral) curvature of the spine, or backbone. The bones that make up the spine are called vertebrae. Below are pictures of a normal spine (right) and of common scoliosis curves (left):
Who gets Scoliosis?
There are many forms of scoliosis however Adolescent idiopathic scoliosis is the most common type (80-85%) and occurs after the age of 10. The term idiopathic means of unknown origin or unknown cause. Girls are more likely than boys to have this type of scoliosis. People of all ages can have scoliosis, but the focus of treatment is on children and adolescents. Of every 1,000 children, 3 to 5 develop spinal curves that are considered large enough to need treatment.
What is the treatment process?
Scoliosis is often noticed by a parent, family member or by a school screening process. From there, referral to an orthopedic spine specialist should take place. The doctor will suggest the best treatment for each patient based on the patient's age, how much more he or she is likely to grow, the degree and pattern of the curve, and the type of scoliosis. A simple x-ray can provide much of this information. From the x-ray, angles can be calculated to determine the exact degree of the curve(s). This is called the Cobb angle. The doctor may recommend observation, bracing, or surgery and here is a general guideline of how that decision is made:
Observation - Doctors follow patients without treatment and re-examine them every 4 to 6 months when the patient is still growing (is skeletally immature) and has an idiopathic curve of less than 25 degrees.
Note: Determining timeline of growth remaining is done by two primary ways. (1) Time since onset of first menstrual cycle in females and (2) using the Risser sign. The Risser sign is capping of the iliac crest (something that can be seen in the x-ray) where experienced professionals can discern roughly how much longer that person will continue to grow.
Bracing - Doctors advise patients to wear a brace to stop a curve from getting any worse when the patient:
o - is still growing and has an idiopathic curve that is more than 25 to 30 degrees
o - has at least 2 years of growth remaining, has an idiopathic curve that is between 20 and 29 degrees, and, if a girl, has not had her first menstrual period
o - is still growing and has an idiopathic curve between 20 and 29 degrees that is getting worse.
Note: As mentioned, braces are designed to prevent the curve from getting worse. The long-term goal is to have the same degree curve at start of treatment as at discharge from the brace (after growth stops).
Surgery - Doctors advise patients to have surgery to correct a curve or stop it from worsening when the patient is still growing, has a curve that is more than 45 degrees AND has a curve that is getting worse.
Determination of brace design
The decision about which brace to wear depends on the type & location of curve. For example, the curve may be an "S" type or double curve affecting the thoracic & lumbar regions of the spine. This variety would be considered a TLSO for short or a "Thoraco-Lumbar-Sacral Orthosis¨. In a curve of any kind, you will always have the sacral orthosis portion. This is how the brace is locked into the body, by firming grabbing the anatomical waist & pelvis.
Some curves primarily affect the lumbar region and have little to no impact above that area. In these cases, a simple LSO or "Lumbar-Sacral Orthosis¨ can be utilized. Unfortunately, with curves higher than T8 (above thoracic vertebra 8) a more cumbersome brace is required for the best results. This is referred to as a Milwaukee brace or a Boston Brace with Superstructure.
Whatever your child's type or location of curve, rest assured the staff at our NOPCO locations or at our Clinical Partners will provide the ideal brace for the best results. As mentioned above & as shown in our results, Boston Brace is the Gold standard in treatment for Adolescent Idiopathic Scoliosis.
Other forms of Scoliosis
Early onset or infantile idiopathic scoliosis - occurs in children younger than 3 years old. It is more common in Europe than in the United States.
Juvenile idiopathic scoliosis - occurs in children between the ages of 3 and 10.
Neuromuscular scoliosis - occurs in individuals of any age and secondary to another diagnosis such as Cerebral Palsy (CP) where significant weakness or conversely significant high tone or spasticity is present. In either case, this muscular imbalance & lack of trunk stability, over time, cause curvature of the spine. Unlike the other forms of scoliosis, individuals with neuromuscular scoliosis typically do not tolerate this form of bracing due to rigidity. Therefore, something more comfortable & forgiven is typically the brace of choice. Please see our Boston Soft Body Jacket.
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