Spinal Casting

Casting for Infantile (Early Onset) Scoliosis

One challenge of early onset scoliosis is not only stopping progression, but also allowing the rib cage to grow so lungs can mature and function normally as your child ages. We use a special style of casting known as elongation-derotation-flexion (EDF) casting.

EDF casting can control the spinal curve’s progress, and in some cases, may actually correct the curve. Casting may also be used as the definitive treatment for a child with early onset scoliosis. Scoliosis is a three-dimensional deformity of the spine, which includes the frontal, sagittal and axial planes. That is why we use a nonsurgical, custom-casting technique that fits over the torso and is based on a three-dimensional correction concept.

Casting is not 100 percent effective for correcting scoliosis in young children. EDF casting may be used to slow the progression of a spinal curve and delay surgery until the child is older. This delay is important because the chest wall and lungs need to grow and mature before there can be any fusion-type surgery to correct this area.

What to expect

  • There is a specially designed table to help apply the cast.
  • The casts will either fit under the arms to the waist, or sometimes over the shoulders down to the waist, based on where the spinal curve is located.
  • The casts are typically worn for 3 months at a time and are sometimes combined with bracing to allow for periods of rest from the cast. 

Spinal Bracing

A spinal brace for scoliosis is designed to keep a curve from progressing. A brace does not improve the curve. The brace is often called a TLSO, which stands for thoracolumbosacral orthosis (orthosis is another word for brace).

In general, braces are recommended for curves between 20-40 degrees in a child who still has a major amount of growing to do. There are times when a healthcare provider may brace a curve that is slightly smaller. Braces are not often prescribed for a curve greater than 40 degrees because those curves are too big for a brace to work well. Your child’s doctor will talk about all of the treatment choices. 

Spinal braces are often made of plastic and are worn around the torso—the upper part the body. With our advanced technology, custom made spinal braces can be made from an external digital scan. This safe, non-invasive tool ensures a custom fit and enables your clinician and physician to design each brace for the individual child and her specific curve.

You child’s doctor will determine what type of spinal brace works best for your child, depending on your child’s age or condition. Your child may have to be fitted for a new brace or switch to a different brace as he or she grows. At Children’s, we offer the following types of spinal braces, including:

Boston

The Boston brace is the most common brace used for idiopathic scoliosis. It uses the hips as a base point and goes up to about the shoulder blades. This brace has interior foam pads that press on the child’s ribs to straighten the spine. The Boston brace was developed in Boston in the 1970s. It is made of many different prefabricated pieces that are placed together to give your child the custom corrective forces that are needed. The Boston brace works best when worn for as many hours as possible during the day. Ideally, your child should wear the brace 23 hours a day—only removing it for bathing and sporting events. Studies have shown that wearing this brace for less than 12 hours a day is not likely to help at all. The brace itself is fairly rigid. It begins just under the level of the axilla (underarm), and ends at the level of the tops of the femur bones (thighbone). A seamless shirt is typically worn under the brace.

Modified Boston

The Modified Boston Brace was developed at Children’s. Based on the Boston and Milwaukee systems, the brace starts at the hips and reaches just below the chest and shoulder blades. We use a cast or 3D scan to create a customized brace for each patient. More than 1,200 patients have been treated with this brace at Children’s.

Providence

The Providence Brace pushes the child’s body to straighten the spine. It is only worn while sleeping, so does not limit daytime activities. The Providence Brace was first introduced in the early 1990s at the Children's Hospital in Rhode Island. It is a brace that is meant to be worn only at night. Like the Boston Brace, it is a rigid plastic brace that is fitted from the underarm to the tops of the thighbones. The Providence brace is a bending brace that not only corrects the front view, it is also intended to straighten the spine, since rotation is the chief deformity in scoliosis. Because the brace tends to overcorrect, it can only be worn in the evening time. Typical recommendations are to wear the brace between 9 to 12 hours in the evenings.

Charleston

The Charleston Brace over-corrects a curve by bending to the other side, and is usually used for single curves. It is only worn while sleeping.

Extension TLSO

An Extension TLSO (thoracolumbosacral orthosis) is used mostly for kyphoscoliosis, a musculoskeletal disorder. It can also be used for Scheuermann's disease. It is designed to reduce kyphosis, or forward bending of the upper trunk as seen from the side.

For post-operative patients or patients with neuromuscular disorders, a Custom TLSO is designed. These are typically foam with a plastic frame and more flexible than other braces.

Bracing Results

Braces are not 100 percent effective at preventing curve progression. There are many factors that affect how well a brace works; some can be modified and some cannot. Three things must be done for a brace to work well:

  • Your child has to wear the brace for the prescribed amount of time.
  • The brace has to provide the proper amount of correction.
  • The brace needs to be worn correctly and adjusted regularly.

Our team wants to work closely with you and your child to help your child enjoy a healthy, active life. To help ensure success, we recommend:

  • Regular checkups with your orthopaedic surgeon (typically every four to six months) during scoliosis treatment.
  • An "in-brace X-ray" to make sure the brace is providing the right amount of corrective force.
  • Frequent follow-up visits with the orthotist to make sure the brace is correctly fitted. 

The most important factor for brace success is how many hours per day a brace is worn. Your orthotist will work closely with you, your child and his orthopaedic surgeon to design a brace that is optimized for his curve and life.

Frequently Asked Questions

Can my child still do sports with a brace?

Typically, your child can perform sports no matter how severe the scoliosis is. If your child wears an "all-day" brace such as the Boston Brace, we would typically recommend that your child perform sports without wearing it. It’s important to consult your child’s doctor about any sport to help make sure it’s safe.

How long does my child have to wear a brace?

Your child will wear the brace until he or she is no longer growing. On average this is about age 14 in girls and 16 in boys.

Is the brace comfortable?

The brace itself is rigid and takes time to get used to. The orthotist will help your child adjust to the brace. While braces may not be comfortable, they should not be painful. If the brace is painful, contact your orthotist to see if it can be adjusted to make it more comfortable.

Will people see the brace under my child's clothes?

It depends on the type of clothes your child wears. With baggier clothes, the brace will likely not be easy to see. But, for more tightly fitting clothes, the brace may be visible.