Pulmonary restrictive effect ofbracing inmild idiopathic scoliosis

Theuseofbracing inthetreatment ofmild idiopathic scoliosis iscontroversial. Astudy of 33adolescents showedthatbracing significantly decreased lungvolumes. Functional residual capacity was reduced byamean of26%,18%ofchildren showing areduction ofgreater than40%. Themean reduction intotal lung capacity was 16%andinforced vital capacity 18%.Thisrestriction oflungfunction bybracing mighthavea deleterious effect on lunggrowth ormightimpose an additional risk factor inthe presenceofother disorders, such asasthma anddiaphragmatic weakness. Theuseofbracing inindividuals withmildscoliosis should bejudiciously reassessed. Scoliosis isoneofman'searliest knownphysical deformities. Ithasbeendepicted incavedrawings, noted inthemummified remains ofthepharaohs, and aroused fear inVictor Hugo's tale ofQuasimodo, the Hunchback ofNotreDame. Despite this long history, its treatment, particularly bracing, remains controversial. Theuseofbracing in themanagement ofscoliosis began during the1940s withtheintroduction oftheMilwaukee brace, designed tostabilise thespine postoperatively.' During the1950s and1960s bracing began tobeused inthenon-operative management ofscoliosis. During the1970s theBoston brace wasintroduced.2 There is continuing debate inorthopaedic publications about theindications andeffectiveness ofbracing program- mes.3 4 Although braces havebeenusedextensively inthe past 30years, their effect onunderlying lung function andchest wallmechanics islargely unknown. We report theeffect ofbracing onlungvolumes in33 adolescents withidiopathic scoliosis. Patients andmethods