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

Spinal braces are often made of plastic and are worn around the torso—the upper part the body.

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:

  • 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.
  • 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. 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.
  • 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.
  • Custom TLSO: The Custom TLSO (thoracolumbosacral orthosis) is usually used after surgery or by patients with neuromuscular scoliosis. It is foam with a plastic frame and is more flexible than other braces.
  • Hyperextension TLSO: A Hyperextension TLSO (thoracolumbosacral orthosis) is used mostly for kyphoscoliosis, a musculoskeletal disorder.

Spinal braces can feel uncomfortable at first. The doctor and orthotist can help with discomfort. Most children adjust fairly quickly.

Your child will be able to take part in many activities while wearing the brace. Talk to your doctor about what is safe.

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, Mass., in the 1970s. It is made by taking a series of measurements of the child’s body, and an external digital scan or cast of the torso may also be used. The Boston brace works best when worn for the majority of the day. Research has shown that the more hours a brace is worn, the more likely it is to be successful, and that wearing this brace for less than 12 hours a day is not likely to help at all. Your physician will prescribe a daily wear time goal based on the unique aspects of your scoliosis. 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 (thigh bone). A seamless shirt is typically worn under the brace.

Rigo Cheneau

The Rigo Cheneau brace has been offered at Children’s since 2018. Our orthotists work in partnership with Luke Stikeleather, CO, at the National Scoliosis Center to provide this orthosis. Like the Boston brace, the Rigo Cheneau brace is most likely to be successful when it is worn the majority of the day and night. Within the brace, there are areas of corrective pressure and areas of void (no pressure) that are designed to restore balance to the spine in all three planes. The brace is designed by taking a series of measurements, a scan and pictures of the child. It is made of plastic, with padding added as needed, and it opens in the front.

Providence

Some patients, such as those with smaller curves or are close to being done growing, may benefit from nighttime only bracing. The Providence brace is a brace that is designed to be worn only while sleeping, so it 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 thigh bones. The brace is optimized to be worn while lying down. Typical recommendations are to wear the brace between nine and 12 hours each night.

Extension TLSO

For patients with kyphosis, or forward curvature of the spine, an extension TLSO may be beneficial. This type of orthosis is similar in design to the Boston brace, with the addition of a plastic and metal piece at the front of the chest to extend the spine.

Flexible TLSO

For patients with kyphosis, or forward curvature of the spine, an extension TLSO may be beneficial. This type of orthosis is similar in design to the Boston brace, with the addition of a plastic and metal piece at the front of the chest to extend the spine.

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.

Patient family support services

Children's offers a private Facebook group where our scoliosis families can better communicate with each other—and us. These groups have become lively forums for asking questions, sharing tips and celebrating milestones with one another.

Learn more about our private Facebook group 

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