Bracing for scoliosis.

Bracing is the oldest treatment known for scoliotic spinal deformity. The relative advantages to the use of bracing have been directly related to the etiology of the deformity and the flexibility of the spine at the time that a decision is made regarding the use of a brace. In skeletally immature patients with adolescent idiopathic scoliosis, the advantages to bracing are clear. In many instances, prompt recognition and appropriate bracing can arrest the progression of this form of deformity, and, in so doing, the need for any surgery may be avoided completely. On the other hand, in skeletally mature adult deformity patients, bracing has almost no proven role in affecting the natural history of the disease. Likewise, infantile and congenital scoliosis routinely requires surgical correction to prevent curve progression. Lastly, although many surgeons use bracing in the postoperative management of patients with spinal deformity, the benefits of postoperative bracing remain debatable. By far, the best indication for bracing is treatment of the skeletally immature adolescent patient with an idiopathic flexible curve of less than 45 degrees magnitude.