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How often should a brace be changed?

Receiving their first brace is a key moment in the treatment of youngsters affected by spinal deformities.
This is the brace that shows them exactly what the treatment consists of. They learn about the pads, which are carefully positioned to correct their back; they become familiar with the fastener and how to adjust it to the right tightness, as well as how the brace sits under the armpits. They also have to get used to the shoulder pads and, quite simply, the weight of the plastic.

Surprising as it may seem, some youngsters even grow quite attached to their first brace as, over the weeks and months, it starts to become a part of their daily life and less of a problem. This “friend”, which they sometimes find irritating, especially early on, gradually feels less and less bulky, and in fact there will eventually come a point when it is too small. After all, while the brace stays the same, the youngster inside it grows of course!

For this reason, a new brace will be needed from time to time. It certainly isn’t possible to use the same one from the start to the end of the treatment. But there are also other reasons why a brace needs to be replaced, the first and most obvious being that, like any object used on a daily basis and for a number of hours each day, it starts to wear out. Indeed, after a time, it is subject to breaking, or some of its parts may no longer be intact.

A further reason, and this is perhaps the most important, is that the brace, especially the first one, moulds the youngster’s back so much that after a few months it becomes necessary to construct a new one adapted to its changing volumes. Unless braces are updated to take this aspect into account, they simply cannot work at full efficiency.

The young scoliosis patient’s back changes not only as an effect of the brace, but also because he/she is normally still growing.
In this stage of development, it is perfectly normal to get taller and heavier. A brace can usually tolerate slight increases in height and weight, but when these are more marked it will start to feel uncomfortable. Even just looking at the youngster in his/her brace can be enough to tell you that the time has come to start thinking about getting a new one made.  
From the second brace onwards, more time can usually elapse between braces. It may even be enough to get a new one about once a year.

Youngsters are often anxious at the prospect of changing their brace, fearing that the new one will be uncomfortable. Actually, however, they are unlikely to experience the same discomfort they had at the very start of the treatment.
In fact, in most cases they will find the new brace is more “comfortable”, given that it replaces one that had become too short and tight, and so no longer adequate. Furthermore, having already had to get used to wearing a brace, these “experienced” patients will be better able to recognise, quickly, any problems with the new one.
This will allow them to give the orthopaedic technician clear feedback, useful for making it fit better.  

My treatment hasn’t had the desired effect: why?

Sometimes, even when a patient has followed the prescribed course of treatment (bracing and exercises), the final outcome isn’t what they expected and there are no marked improvements. Why is this?

Let’s start by reiterating something we all know to be a fact.

Scoliosis is a disease that can strike with varying degrees of severity and, as we have said many times, its origin is not known. However, although we don’t know what causes it, thanks to scientific research we are learning more and more about how it evolves and how to treat it.

The vast body of scientific literature now available on this topic has shown us the importance of monitoring scoliosis and its evolution during skeletal growth, in particular during the pubertal growth spurt, which is known to be the most critical phase in the course of this disease.

The aim of conservative treatment, which includes specific exercises and bracing, is to limit the progression of scoliosis during growth, so as to prevent problems from arising in adulthood, and to try and avoid the need to perform highly invasive surgery.

The risk of the disease worsening differs from patient to patient and from curve to curve. Unfortunately, there are no elements that allow us to predict this risk; all we have are indicators that can tell us how likely it is that the condition will worsen and, even then, we are only talking in terms of probabilities. Therefore, the task of the medical team responsible for making the diagnosis and treating the patient is to constantly monitor the situation and adjust the treatment as necessary. After all, we do not want to be too aggressive, but at the same time we need to avoid the risk of underestimating the case and prescribing an ineffective treatment.

The other key factor for a successful outcome is the patient’s “adherence” to the prescribed treatment, in other words his/her ability to follow it constantly and with precision.

How much do these two factors influence the result?

A few years ago, we did a study of “extreme” cases (less than 3% of the total), i.e. those patients showing the best and worst treatment outcomes, defined respectively as a greater than 20° improvement or a greater than 20° worsening of the curve. 

We found that all the patients (100%) who obtained exceptional results were treated with both bracing and exercises. But we also found that 50% of the patients with the poorest outcomes had nevertheless followed the treatment perfectly. In these cases, while the treatment had failed to arrest the course of particularly aggressive forms of scoliosis, the patients’ adherence to it had undoubtedly slowed down the worsening of the curve and prevented it from being as marked as it would have been without any treatment at all. And this brings us back to what we said at the start: although some cases show no apparent improvements, scoliosis that has worsened a little at the end of treatment must be considered a great success if the outcome of no treatment would have been a far more severe deterioration.

So, what do we ask of our patients? To collaborate, adhering to the treatment fully and regularly attending check-ups, so as not to run the risk of obtaining disappointing results, despite being treated.