Night-time braces for treatment of Adolescent Idiopathic Scoliosis

Purpose. This review article aims at providing an update on the basic science and clinical information underlying the use of nocturnal braces for adolescent idiopathic scoliosis. Method. The National Institutes of Health online medical database (Medline) was used to retrieve all articles pertinent to clinical research on night-time bracing; data were also collected from manufacturing companies. Additional information was obtained from literature on pathomechanics of scoliosis. Results. The cardinal feature of night-time braces lays in their ability to hypercorrect the scoliotic curvature, thereby eliminating the asymmetric water accumulation that occurs in the apical and adjacent intervertebral discs. Previously wedge-shaped discs resume a nearly cylindrical configuration, thus restoring a close-to-normal force application to the endplates through the Hueter-Volkmann principle and preventing curve progression. The two night-time braces mostly used hypercorrect the spine through different mechanisms. Conclusions. On the basis of clinical results available, night-time braces constitute an attractive option for single-major lumbar/thoracolumbar curves not exceeding 358 in magnitude. Multi-center, randomized studies using strict criteria set forth by the Scoliosis Research Society (SRS) and the Society on Spinal Orthopaedic and Rehabilitation Treatment (SOSORT) are needed to better define the role of nocturnal bracing in the conservative treatment of adolescent idiopathic scoliosis.