Scoliosis correction
When working toward non-surgical scoliosis correction, asymmetric bracing has been shown to be more effective than symmetric scoliosis braces (1). 3D Chêneau-style bracing is specifically designed to positively influence the spine toward the normal physiologic position and allow for improved longitudinal growth. This is accomplished by reducing asymmetric loading to induce the greatest possible in-brace correction.
To achieve this goal, each brace attempts to remove the compressive forces that inhibit growth in the scoliotic spine. This is per the Hueter-Volkmann principle which states that skeletal growth is reduced by increased compressive forces (in scoliosis, the concave side) and accelerated on the opposing side (in scoliosis, the convex side) as a result of the reduced mechanical compressive forces. According to Stokes, “sustained compression” inhibits growth by 40% or more while distraction on the opposing side increases the skeletal growth rate. He refers to this phenomenon as mechanical loading or asymmetric loading.
The well-designed scoliosis brace should work synergistically to reduce the compressive forces of scoliosis in the frontal, sagittal, and transverse planes, thereby reducing asymmetric loading during growth to improve spinal alignment. This means that the patient has an improved chance of longitudinal growth and stabilization or even scoliosis correction. From a physical and radiological standpoint, the goals are to cosmetically improve posture, improve spinal balance, and Cobb angle , when possible. Chêneau concept braces work to achieve this by incorporating pressure zones over the convexities with opposing voids over the spinal concavities. This allows for corrective movement so Schroth breathing (corrective, derotational breathing) can occur while the patient wears the brace. While these are the stated principles of all Chêneau braces, not all braces succeed in attaining this goal.
We recommend braces created from a 3D scan of the patient’s body with a built in correction effect and a brace design that attempts to create a mirror image of the patients’ scoliotic curve pattern for patients with mild scoliosis or improved shift toward the midline for more severe curves. During consecutive brace fittings, practitioners should focus on adjusting the brace for comfort and optimal pad positioning to enhance the built-in correction effect of the scoliosis brace.
For a successful bracing experience, in-brace correction is of utmost importance to outcome at the end of brace wear whether the treatment had been with one brace or a series of braces. Landauer et. al correlated an in-brace correction effect of 40% to a reduction in thoracic Cobb angle of 7º at the conclusion of braces wear. It stands to reason that the greater the in-brace correction, the more potential for some extent of scoliosis correction at skeletal maturity (3).
Patients and parents should know that the potential for scoliosis correction will vary by patient (spinal flexibility, type oor curve patttern of scoliosis, compliance) and brace management (monitor, adjust if needed, and replace at certain intervals of growth – depending on the individual and the brace). Generally, less skeletally mature patients with more flexible spines are more likely to experience better in-brace corrections. However, results will vary by individual.
(1) Ng SY, Borysov M, Moramarco M, Nan XF, Weiss HR. Bracing Scoliosis – State of the Art Mini Review. Current Pediatric Reviews 2016;12(36-42).
(2) Stokes, IAF, Mechanical effects on skeletal growth. J Musculoskel Neuron Interact 2000;2(3):277-280.
(3)Landauer F, Wimmer C, Behensky H. Estimating the final outcome of brace treatment for idiopathic thoracic scoliosis at 6-month follow-up. Pediatric Rehab 2003; 6(3-4):201-7.
