Monitoring: clinical examination for trunk asymmetry using the Adam's forward bend test (scoliometer measurement). Standing full-spine X-rays (PA and lateral) at intervals determined by age and curve magnitude. Low-dose imaging protocols (EOS) reduce radiation. Bracing: a custom-moulded rigid brace (Boston, Chêneau, or night-time Providence) is worn for the prescribed number of hours daily (typically 18–23 hours for full-time bracing, 8–10 hours for night-time bracing). The brace applies corrective forces to the curve.
Monitoring is recommended for all children with scoliosis greater than 10 degrees, particularly during the growth spurt (ages 10–15 in girls, 12–17 in boys). Bracing is recommended for curves between 25–45 degrees in skeletally immature patients (Risser 0–2) to prevent progression to the surgical threshold.
Physiotherapy (Schroth method — scoliosis-specific exercises), observation alone for small curves, and acceptance of the curve if the patient is near skeletal maturity and the curve is stable.
Not a surgical procedure. Initial full-spine X-rays for baseline. Bone age assessment (hand X-ray or Risser sign) to estimate remaining growth.
The BrAIST trial demonstrated that bracing successfully prevents curve progression to the surgical threshold in approximately 72% of patients with curves 25–40 degrees, compared to 48% with observation alone. The more hours the brace is worn, the better the outcome.
Non-complianceCommon
The biggest challenge. Adolescents may resist wearing the brace, particularly during school hours and social situations.
Skin irritationCommon
Pressure sores, redness, and discomfort under the brace.
Psychological impactCommon
Body image concerns, social embarrassment, and frustration.
Curve progression despite bracingUncommon
Approximately 28% of braced patients still progress to the surgical threshold.
Missed progressionRare
If monitoring intervals are too long, rapid curve progression may be missed.
OvercorrectionRare
Very rare with modern bracing.
Rib deformityUncommon
Pressure from the brace may cause temporary rib cage asymmetry.
No anaesthesia required. Bracing is entirely non-invasive.
Bracing continues until skeletal maturity (Risser 4–5, typically age 15–17 in girls, 17–19 in boys). Gradual weaning over six to twelve months. Scoliosis-specific physiotherapy throughout. Sport and physical activity are encouraged — the brace is removed for sport. Final assessment at skeletal maturity determines whether the curve is stable.
X-rays every four to six months during the growth spurt. Clinical review at each visit. Brace adjustment as the child grows. Final assessment at skeletal maturity.
Does my child definitely need a brace?
Bracing is recommended for curves between 25–45 degrees in growing children. Below 25 degrees, observation is usually sufficient. Above 45 degrees, surgery is typically discussed. The decision depends on the curve magnitude, remaining growth, and risk of progression.
How many hours per day?
Full-time bracing (18–23 hours/day) is most effective. The BrAIST trial showed a dose-response — more hours equals better results. Night-time-only bracing (8–10 hours) is an option for moderate curves but is less effective for larger curves.
Can my child still do sport?
Yes — sport and physical activity are strongly encouraged. The brace is removed for sport and physical education. Swimming, dance, and gymnastics are particularly beneficial for core strength and flexibility.
Will the curve get worse after bracing stops?
Curves that remain below 30 degrees at skeletal maturity are unlikely to progress significantly in adulthood. Curves above 50 degrees at maturity tend to progress slowly (approximately 1 degree per year) and may eventually require surgery.