Library Type: Condition

Congenital Scoliosis

Diagnosis

The diagnosis is made by a doctor and confirmed by an orthopedist who will order an X-ray and other tests.

Treatment

The curvatures of the spine caused directly by the affected bones are very rigid and will not straighten. Many times, there are other abnormal curvatures, called compensatory curves, that form above or below due to the rigid, affected sections of the spine. These compensatory curves are flexible and may be considered for treatment with spinal bracing, most commonly a thoracic lumbar sacral orthosis (TLSO).

Mehta Casting

Serial, or Mehta, spinal plaster casting is used to stop the progression of the curve and delay surgical intervention. Mehta casting is designed to utilize patient growth in a corrected position to correct scoliotic curves. The procedure is typically performed under sedation and fluoroscopy (a live X-ray) to ensure a high degree of accuracy by the orthopedic surgeon. 

Spinal bracing plays a role in the spinal serial casting program. Braces are used during “brace holidays” in order to maintain the correction achieved in the casts before the next cast is applied.  Your orthopedic surgeon will determine the best opportunity for these brace holidays. 

Your Hanger orthotist can help determine the proper type of spinal brace with a diagnosis of congenital scoliosis. Braces need to be worn for 18-22 hours per day. Lesser time in a TLSO can lead to an increased risk of curve recurrence after improvement with Mehta casting. 

Both the congenital and compensatory curves are at risk of worsening during skeletal growth. Orthotic intervention can help delay the need for surgical correction, allowing the child normal growth potential.

Pectus Carinatum

Treatment

The most common treatment for pectus carinatum is the use of a compressive brace during times of growth. This brace wraps around the chest and applies a light, gradual pressure over the projected area to reshape the chest wall while the patient is growing. This can be custom-made or off-the-shelf, depending on the child’s body shape and location of the projected area. The amount of correction achieved directly relates to the amount of time the child wears the brace. Ideally, they will wear the brace 16 to 23 hours a day through their adolescent growth spurt. As the chest wall reshapes and the patient grows, follow-up appointments will be necessary to make sure the brace continues to fit and function correctly.

Research has shown that patients who wear their brace for the prescribed amount of time have significant improvement in appearance and long-term correction, eliminating the need for surgical intervention. If left untreated, pectus carinatum can progress, becoming more noticeable and permanent as a person reaches skeletal maturity. Once a patient has finished growing and has reached skeletal maturity, an orthotic brace is no longer an effective treatment and surgical intervention may be an option. 


Jung, Joonho et al. “Brace compression for treatment of pectus carinatum.” The Korean journal of thoracic and cardiovascular surgery vol. 45,6 (2012): 396-400. doi:10.5090/kjtcs.2012.45.6.396 | Lee, Richy T et al. “Bracing is an effective therapy for pectus carinatum: interim results.” Journal of pediatric surgery vol. 48,1 (2013): 184-90. doi:10.1016/j.jpedsurg.2012.10.037 | Moon, Duk Hwan et al. “Long-Term Results of Compressive Brace Therapy for Pectus Carinatum.” The Thoracic and cardiovascular surgeon vol. 67,1 (2019): 67-72. doi:10.1055/s-0038-1669927

Neuromuscular Scoliosis

Diagnosis

The diagnosis may be confirmed through a physical assessment by an orthopedist, neurosurgeon, or neurologist. Typically, a radiograph is taken to confirm the alignment of the spine and the magnitude of the curve. X-rays are usually taken at regular intervals to confirm any changes in the scoliotic curves and to confirm if the curves are responding to brace treatment.  

Treatment

Early intervention is important. Neuromuscular scoliosis is much more likely to produce curves that progress, and continue progressing into adulthood. As the scoliosis curve magnitude increases, the patient may develop progressive loss of balance and later have difficulty with mobility and walking. If left untreated, the curve may become less flexible, causing seating issues, hygiene issues, and possibly leading to thoracic insufficiency syndrome and interfering with lung function.

A spinal orthosis or custom thoracic lumbar sacral orthosis (TLSO) can be prescribed as a means to improve spinal alignment. The main goal of this orthosis is to provide stability, alignment of the spine, and sitting balance to encourage independence of the patient’s arms and hands. With the custom TLSO, enhancements and customizations can be made to accommodate for other indications based on the patient’s condition. For patients in a wheelchair, the brace can be worn to assist with transferring from a wheelchair to the bed and to improve head and neck alignment. The brace does not correct and may not prevent the progression of spinal curvature in a patient with neuromuscular scoliosis. The goal is to improve spinal alignment and increase the patient’s function. 

Because children with neuromuscular scoliosis can have a range of medical issues in addition to the spinal curve, treatment involves a team of doctors and healthcare professionals from different medical specialties working together to provide care.


Neuromuscular Scoliosis. Scoliosis Research Society.

Scheuermann’s Kyphosis

Treatment

Many patients do not experience serious problems, but in severe cases, and if left untreated, kyphosis can cause damage to the spine and other areas of the body. 

There are three proven treatments for kyphosis: — monitoring, bracing, and surgery. Your physician will recommend which one of these treatments is appropriate based on the severity of the curve and age of your child.

  • Bracing can be effective in many cases to stop the progression of kyphosis, and treatment will be needed until your child stops growing. The goal of bracing is to prevent additional kyphosis by hyperextending the spine to reduce wedging of the affected bones. Kyphosis braces are usually worn 16-20 hours per day and removed for all contact sports until the child is through puberty.
  • Physical therapy may also be suggested to stretch and strengthen the muscles of the spine and core, concentrating on extension exercises.
  • Surgery is also an option your physician may discuss. Oftentimes, surgery may be recommended if bracing was ineffective or the curve is being treated after puberty.

Treatment for kyphosis should be considered a team approach that involves the physician, orthotist, physical therapist, your family, and most importantly the patient.

Burn Injuries

Wearing time for the compression therapy is anywhere from 6-12 months, or as long as the burn team feels the burns are still “active”. Active refers to the state in which the burn is still healing and can change into hypertrophic scarring.

Compression therapy is widely viewed as essential to minimize scarring. The theory behind compression therapy is to reduce the blood flow to the area of the burn, as well as to apply continuous pressure to the burn to stop the growth of scar tissue. It is important to note that compression therapy is just one part of the rehabilitation of burn injuries. Your burn team will most likely include splinting (bracing), exercise, and scar mobility as part of the plan.


1. Atiyeh, B S et al. “Pressure garment therapy (PGT) of burn scars: evidence-based efficacy.” Annals of burns and fire disasters vol. 26,4 (2013): 205-12.
2. Krishnamoorthy, Vijay et al. “Pediatric burn injuries.” International journal of critical illness and injury science vol. 2,3 (2012): 128-34.

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