Scoliosis Bracing

Indications

Neuromuscular Scoliosis, standing radiograph of a scoliosis with the cobb angle marked
Standing radiograph of a scoliosis with the Cobb angle marked. Image by HR Weiss, S Seibel, A Kleban Annotated by Mikael Häggström, M.D. Author info – Reusing images- Conflicts of interest: None Mikael Häggström, M.D., Wikimedia Commons, CC BY 4.0.
  • Adolescent idiopathic scoliosis with Cobb angle 25 to 40 degrees
  • Skeletally immature, Risser 0 to 2
  • Aim is to stop progression. The curve is not permanently corrected
  • Curves of 20 to 25 degrees that show progression of 5 degrees or more
  • Bracing is less effective in congenital and neuromuscular curves

Evidence

  • BrAIST trial (Weinstein, NEJM 2013) found bracing reduced progression to surgical range
  • Treatment success 72% with bracing against 48% with observation
  • Benefit rose with hours of wear, aim for 18 hours or more a day

Types

BraceUse
TLSO (Boston)Apex at T7 or below. Most used
Milwaukee CTLSOApex above T7. Rarely used
Night time bending brace (Providence, Charleston)Single lumbar or thoracolumbar curves

Monitoring

  • In brace X-ray to confirm correction
  • Standing X-ray every 4 to 6 months out of the brace
  • Wean at skeletal maturity, Risser 4 or about 2 years after menarche
  • Check skin for pressure areas
  • Discuss psychological effects and compliance with the family

Limitations

  • Curves over 45 degrees respond poorly and need surgical review
  • Poor compliance reduces effect
  • In neuromuscular scoliosis bracing helps sitting but does not prevent progression
  • Temperature sensors measure compliance
  • Curves may progress after brace removal, especially above 40 degrees
  • Body image and comfort affect wear time

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.