Scoliosis in adults refers to an abnormal sideways curvature of the spine that occurs after skeletal maturity. This condition presents in two primary ways: as a progression of adolescent idiopathic scoliosis (AIS) that worsens over time, or as de novo scoliosis, which develops anew in adulthood. De novo adult scoliosis is typically degenerative, arising from the asymmetrical wear and tear of spinal structures, such as the intervertebral discs and facet joints, often after age 40. Unlike AIS, which is often painless in adolescents, the adult spine frequently experiences chronic back pain, postural imbalance, and functional limitations due to compression and instability.
How Adult Bracing Differs From Adolescent Treatment
The core distinction in bracing lies in the treatment objective. For a growing teenager, the primary goal is to prevent curve progression and achieve some correction while the spine is still malleable. This requires wearing a rigid brace for many hours a day (often 16 to 20 hours) to physically guide the spine’s growth.
In a skeletally mature adult, the spine is no longer growing, so a brace cannot effectively correct a fixed curvature or halt progression. The objective shifts entirely from structural correction to symptom management and stabilization. Adult bracing is primarily a mechanical tool used to reduce pain, improve postural balance, and decrease muscle fatigue.
The brace provides external support that offloads the strain on the spinal muscles, which are often overworked trying to maintain an upright posture against the curvature and gravity. This mechanical stabilization can significantly relieve the chronic discomfort that is a hallmark of adult scoliosis, especially when the condition is compressive. Therefore, the efficacy of an adult brace is measured by improved function and decreased pain levels, rather than a significant reduction in the Cobb angle.
Types of Orthoses Used for Adult Scoliosis
The devices used for adult support are generally distinct from the rigid, corrective braces used for adolescents. The most commonly prescribed orthoses fall into two categories based on the area of the spine they cover. A Lumbar Sacral Orthosis (LSO) provides targeted support for the lower back and pelvis, the area most often affected by degenerative scoliosis.
A Thoracolumbar Sacral Orthosis (TLSO) provides more comprehensive support, extending from the middle of the back down to the pelvis. These orthoses may be custom-molded for complex curves or significant postural imbalance, or they may be simpler, off-the-shelf elastic supports used for temporary pain relief. The brace works by applying a three-point force system and abdominal compression, which reduces forces on the intervertebral discs and limits spinal motion.
Unlike adolescent bracing, which demands near-full-time wear, adult orthoses are typically worn intermittently. Patients often use the brace during periods of high activity, such as standing or walking for long durations, or during a pain flare-up. Wear schedules usually range from four to twelve hours a day, focusing on times when gravitational effects cause the most strain and fatigue.
When a Brace is Prescribed for Adult Scoliosis
Bracing is usually considered when localized, chronic back pain is not responsive to other conservative treatments. It may also be indicated for individuals with significant trunk shift or postural imbalance that interferes with daily activities. For osteoporotic patients, a supportive brace can help stabilize the spine and potentially reduce the risk of compression fractures.
Bracing is almost always a temporary measure or one tool in a broader management strategy, not a permanent fix. Doctors are cautious about prescribing long-term, continuous brace use due to the risk of muscle atrophy. Relying on external support can weaken the core and paraspinal muscles necessary for long-term spinal stability.
Contraindications for bracing include severe spinal stiffness where the device would limit necessary functional movement, or issues with skin integrity. The decision to use a brace is highly individualized, depending on the curve’s flexibility, the severity of the symptoms, and the patient’s overall health profile.
Comprehensive Non-Surgical Management
Bracing is rarely a standalone treatment for adult scoliosis; it functions best as part of a comprehensive non-surgical management plan. Physical therapy is a fundamental component, focusing on core strengthening and flexibility to build an internal “muscular brace”. Programs like the Schroth method or Scientific Exercise Approach to Scoliosis (SEAS) involve specific exercises tailored to the patient’s curve pattern.
Pain management techniques are often utilized to provide relief and allow for better participation in physical therapy. These can include epidural or nerve block injections, which reduce inflammation and discomfort related to nerve compression or arthritis. Lifestyle adjustments, such as maintaining mindful posture and low-impact activities, further help to minimize stress on the curved spine.
Surgical intervention is typically considered only when conservative measures have failed to control intractable pain, when there is a progressive neurological deficit, or when the spinal curve is severe and progressing rapidly. Most adults with scoliosis can manage their condition effectively without surgery using targeted exercise, pain relief, and intermittent support from an orthosis.