Many recent studies have implicated the use of corset for idiopathic scoliosis in adolescents as a non-surgical treatment strategy to prevent progression of the curve, mainly due to lack of empirical evidence confirming its long-term effectiveness. term, as well as psychological problems directly attributable to the wear of scoliosis. The most commonly used splint in the United States for scoliosis is the thoraco-lumbar-sacral TLSO orthosis, commonly known as the Boston Orthosis. The Boston Scoliosis Brace is primarily used for thoracic curvatures with vertices not greater than T7. Very little attention has been paid to the fact that rigid braces severely restrict the mobility of the abdomen and chest wall. Studies done by the Laboratory of Clinical Physiology at the Ulleval Hospital, which incorporates the use of the Boston Brace (TLSO) at Sophies Minde Orthopedic Hospital in Oslo, in Norway, have demonstrated a significant decrease in lung function at rest and during exercise while wearing the Boston Brace.
The majority of adolescents who are prescribed spinal orthoses are asked to wear their scoliosis brace 23 hours a day. When we begin to dissect the physiological effects, we can understand why wearing Boston Brace or any other corset poses a major compliance problem. The amount of physical discomfort that occurs is in most cases ignored and misunderstood. If someone pressed your chest wall aggressively, then press your abdomen and then hold it for 23 hours a day, how would you feel? The functional loss of the respiratory mechanisms of patients is upsetting and potentially dangerous. Respiratory studies revealed a significant reduction in respiratory capacity as well as export ratios of oxygen and CO2, which resulted in innate neurological adaptation of breathing in order to survive. Most studies, however, indicate that breathing and lung tests have returned to normal once the brace has been removed, but one must ask what type of cellular damage or other health consequences may occur during the brace.
Understanding human physiology, as complex as it may be, can be simplified into a few general facts. Breathing is not only about oxygen delivery and gas exchange, it also has major effects on human health. Breathing has a significant impact on hormonal regulation, including estrogen, progesterone, growth hormone and thyroid hormones. In addition, respiration directly influences muscle and fat composition, as well as cognitive performance. Regardless of whether breathing capacity returns to normal after wearing the Boston scoliosis splint, we may want to discuss its impact on the child's health while wearing it. There is currently no known study on this problem, but it would certainly be interesting to see the impact that could have a limitation of the respiratory capacity 23 hours a day on a growing body.
The Boston Brace mechanically produces pressure on both the chest wall and the abdomen, allowing for minimal compensation in the breathing mechanism. Studies of children wearing Boston Brace have shown a reduction of 30% in vital capacity (VC) and 45% in expiratory reserve volume (ERV), similar to that of long-term smokers. Symptoms related to respiratory distress can include headaches, anxiety, sleep disorders, nightmares and cognitive dysfunction.
It is unfortunate that such invasive treatment is often used in the hope of preventing the progress of scoliosis without regard to how it will affect the child during and after treatment. Such narrow thinking, focused solely on a Cobb angle measure, seems to stifle any other rational thought about the side effects of scoliosis. Recent evidence uncovered by Axial Bio Tech's genetics research team suggests that spinal splint does not alter the natural course of scoliosis, empirical evidence of the significant pulmonary constraint associated with the port of Boston Brace, associated with the known psychological problems associated with wearing the orthotic, parents and their doctor must look closely at the risks versus benefits when they plan to use the Boston Brace.