What is a spinal brace (spinal orthosis)?
At this time in your child’s life, their body is growing quickly. If your child has scoliosis, this rapid growth increases the risk that the curve(s) in their spine will get larger. A spinal orthosis is a back brace that is designed to hold your child’s spine in place and decrease the chance that the curve in their spine will become larger as they grow. By wearing a spinal brace, 80% of curves will stay the same size. Some curves may even get smaller, but this should not be expected.
Your child’s brace will be custom-made to fit them.
Who needs a brace?
Children who are still growing may require a brace, as there is a risk that the curve in their spines will continue to increase. The risk relative to your child’s growth rate is assessed by the maturity of their bones and—for females—when they have begun having menstrual periods.
Types of spinal braces
There are different types of spinal braces that are commonly used to treat scoliosis.
- The most common type is called a thoraco-lumbar-sacral orthosis (TLSO), meaning it goes from under the arms to the level of the hips. This is the most commonly prescribed brace because it treats both single and double curves. This is what your child will likely be wearing. The Cheneau and Rigo System Cheneau are two examples of TLSOs.
- A less common type is called a cervico-thoraco-lumbar-sacral orthosis (CTLSO), which goes from the neck to the level of the hips. The Milwaukee brace is an example of a CTLSO and is prescribed when the curve is high in the back, close to the neck.
- Sometimes, a spinal cast is used instead of (or in combination with) a brace. Spinal casts are made of plaster and are covered in fibreglass. They are often put on in the operating room with your child asleep.
Modern spinal braces
Orthotists have been working to make better spinal braces for children who have scoliosis. Modern spinal braces now weigh less, are more comfortable, and are easier to wear.
How long will my child need to wear a spinal brace?
In order for the brace to work properly, it must be worn full-time, which is about 20 to 22 hours per day. Your child will need to wear a spinal brace until their body stops growing. This will be when they have reached their full adult height. For girls, this occurs about two years after their period starts. Boys usually stop growing by age 16.
Your child’s scoliosis care team will monitor them closely and will determine through X-rays and height measurements when they can safely stop wearing the brace.
Getting a spinal brace
Your child has been referred to the Orthopaedic Clinic because of concerns with their spine. Your child will need to make several visits to the clinic.
- At their first visit, they will be seen by a spine specialist to assess their spine. An X-ray may be taken at this time.
- If a spinal brace is needed, your child will be seen by a certified orthotist. An orthotist is a person who has been trained in making, fitting, and assessing spinal and other orthoses. The first visit with the orthotist may be on the same day as your child’s clinic appointment, or it may be scheduled later. The brace is made based on your child’s X-ray and a 3D scan of their body.
- About a month later, your child will see the orthotist again to receive their brace. They will be educated on how to put on and take off the brace and how to keep it clean.
- About a month after the brace is received, your child will see the orthotist again to have an X-ray taken with the brace on. Any final adjustments will be made. The X-ray should show that the curve in your child’s spine is straighter while wearing the brace.
- The scoliosis care team will see your child approximately every six months, or sooner if needed. Your child’s scoliosis care team may include an orthopedic surgeon, a physical therapy (PT) practitioner, and a certified orthotist.
What happens at the first visit?
Your child’s first appointment with the orthotist takes about an hour. The orthotist will spend some time providing information about spinal braces and answering your questions. Your child will then be given a long body stocking to wear for the assessment and shape acquisition part of the visit.
The orthotist will examine your child, ask you some questions, and then measure your child’s body with a cloth measuring tape and a caliper, which is a type of ruler. A handheld 3D scanner will then be used to obtain a digital computerized copy of your child’s body.
This process is not painful and should only take 15 minutes. Your child can customize the appearance of their brace by choosing the colour of the plastic, images or patterns that can be applied to the brace. Your child can even provide a custom image that is meaningful to them to apply to the brace. Please discuss your child’s options with the orthotist.
What happens at the fitting appointment?
After putting on a body stocking, your child will try on their new spinal brace. The orthotist will mark the plastic to trim some away. This will happen a few times until the trim lines of your child’s brace are right. At this point, the spinal brace is finished and is ready for the final fitting, about an hour later.
The orthotist will speak with you and your child and give you written instructions to make sure your child knows how to use the brace, and how to take care of it and their body.
A fitting appointment may take up to three hours. A lot of time is spent waiting while the orthotist is completing work, so please bring something to keep your child and yourself busy during these down times.
How wearing a spinal brace feels
Your child’s spinal brace will be snug, and there will be pads providing corrective pressure on their spine. Before your child gets used to wearing the spinal brace, they may feel some discomfort from the pressure of the pads. This will decrease over time. Many people who have worn both a spinal brace and braces on the teeth feel that the adjustment process is similar.
Your child will be wearing foam and plastic, so they will likely feel warmer with the brace on. They are not expected to be able to wear the brace full-time at first. Over the course of a month, your child will slowly increase their wear-time until they are comfortable wearing the spinal brace full-time.
Your child will need to wear an undershirt under the brace.
Playing sports
Your child can still play sports with a spinal brace. In fact, it is a good idea for them to be physically active every day. Although the brace restricts some movement in the body, there are some sports and activities that can be done with the brace on. Activities that require your child to correct their balance quickly, or that need increased flexibility or increased air intake, must be done with the brace off. These activities include skating, snowboarding, skiing, horseback riding, gymnastics, dancing and soccer.
Please ask your child’s scoliosis care team about any activity or sports restrictions.
How long does a spinal brace last?
On average, the brace needs to be changed every year as your child grows.
What happens at follow-up appointments?
The first follow-up appointment is scheduled for about four weeks after the fitting appointment. This gives your child enough time to slowly get used to wearing the spinal brace full-time. On the day of the follow-up appointment, an X-ray of your child’s spine will be taken while they are wearing the brace. This helps the orthotist ensure that the pads of the brace are keeping your child’s spine straighter while the brace is being worn. After the X-ray, your child will see the orthotist for final adjustments.
Other follow-up appointments with the orthotist will be scheduled on the same day as clinic follow-up appointments with your child’s scoliosis care team. An appointment may be scheduled sooner if adjustments are needed.
At SickKids
If your child lives in Ontario and has a valid Ontario health card, 75% of your child’s spinal brace will be paid for by the Assistive Devices Program (ADP). The remaining 25% is the responsibility of the family. Many private insurance companies cover some or all of the remaining cost. If you need help paying for your child’s brace, visit our reception desk for a list of charitable organizations that may assist you. Please visit or contact The Children's Orthotics Clinic for further information on pricing.
All proceeds from orthotic treatment at The Children’s Orthotics Clinic go towards supporting patient care and research at SickKids. For more information, please see https://www.sickkids.ca/en/care-services/support-services/childrens-orthotics/.