Orthotic Management for Early Onset Scoliosis

Abstract

This chapter discusses the contemporary role of orthotic treatment for idiopathic early onset scoliosis. Several retrospective studies have demonstrated limited success in bracing this population. However, a recent prospective study in adolescent patients has demonstrated the efficacy of bracing, which may suggest that bracing effectiveness be reconsidered for this population. As recent evidence has shown that there may be a law of diminishing returns with surgical growing rod treatment of early onset scoliosis, it suggests that there is a role for casting and bracing in this population. Goal-oriented thinking is helpful in assessing patients with early onset spinal deformity. Broadly stated goals for early onset spinal deformity patients include achieving maximum spine growth and length, maximum spine flexibility, optimal respiratory function and lung growth, and a minimum of hospitalizations and procedures. A Cobb angle in excess of 20° is a lower threshold for orthotic treatment in idiopathic EOS. Contraindications to bracing include certain curve locations, very large curves, associated thoracic lordosis, advanced chest deformity, and some medical and psychological conditions. There are multiple brace designs currently utilized, but more important, a team approach to management of bracing of all ages is sought at most pediatric deformity centers. Typically, the “team” is composed of physician, orthotist, physical therapist, and nurse or other coordinator. We also view the family and patient as part of the team. Success or failure in bracing depends partly upon the goals chosen for treatment. Establishing realistic, specific, and transparent goals early in orthotic treatment of early onset deformity facilitates rational expectations by the practitioner and family.