Amanda Wilde (Host): When your child is fitted with a spine brace, you want to know what to expect moving forward and how to best support your child. We'll discuss that today with experts dr. John Ghazi, pediatric orthopedic surgeon at Shriner's Children's Chicago, and Bill Craggs, manager of Pediatric Orthotic and Prosthetic Service located in Shriner's Children's Chicago. I'm Amanda Wilde, and this is Pediatric Specialty Care Spotlight with Shriner's Hospitals for Children Chicago. Welcome, Bill Craggs. Welcome Dr. Ghazi. Thanks for being here.

Dr John Ghazi: Thanks for having us.

Bill Craggs: Hello.

Amanda Wilde (Host): Bill, I understand your relatives have been creating braces and orthotics at the Chicago Shriner's Hospital since it opened in 1926. Have there been many changes in braces in these last 100 years?

Bill Craggs: Yes, there's been quite a bit of changes. The advent of plastic and carbon fibers and all that has changed how we create our devices. Early devices were all metal and leather and much bulkier and more difficult for the patient to wear and much less cosmetic. And now, we use low profile thinner braces that are made out of plastic and foams and tend to sit on the body much closer and have a more intimate fit and be more comfortable for the patient.

Amanda Wilde (Host): Yeah, that's key. More comfortable and then the materials have changed and evolved over these years. Can you describe how spine brace works to help a curved spine?

Bill Craggs: All spine braces, there's a bunch of different names and different styles, but they all work the same way by creating a three-point pressure system to push on the curves to make a corrective force.

Amanda Wilde (Host): Dr. Ghazi, I know you became interested in pediatric orthopedics at a young age and grew up with a sister who required extensive orthopedic care throughout her childhood. So, this is very personal for you as well. When a child first gets a brace, what should we expect from that initial adjustment period?

Dr John Ghazi: So, it's always a little bit of an adjustment starting out with a brace. It is something that needs to be worn throughout most of the day. So in the initial period, usually, it just takes some getting used to kind of the feel of having this brace that's usually worn under your clothes during the day. And typically, after a patient is given a brace for the first time, we'll usually see them back in the clinic pretty soon after they first start wearing it, usually after a couple weeks so that we can make any necessary adjustments that need to be made in order to make it more comfortable for them.

Amanda Wilde (Host): So, how would you care, for example, for your child's skin during that period to make it as comfortable as possible? Are there topical things you can do to help with the adjustment?

Dr John Ghazi: Usually, there aren't too many issues with the skin. We usually recommend wearing sort of a silver-impregnated undershirt underneath the brace to help protect the skin and keep it clean. And patients are able to take off the brace for routine bathing and hygiene as well to make sure that they're taking good care of their skin.

Amanda Wilde (Host): And Bill, can you talk about how to care for the device itself?

Bill Craggs: Yes. Generally, the only thing you really have to do is it can be washed with soapy water and towel dried. There isn't a whole lot of maintenance to the brace other than, when they return for clinic visits, there's times where, A, we may have to adjust something or replace the Velcro, or there's specific pads that we add to the brace to make them comfortable that are wear items that we replace regularly as they come for their visits or if they have to come in for a separate visit just to see us for something like that. But they're fairly maintenance-free, just a little bit of weekly cleaning is all that's needed.

Amanda Wilde (Host): Are they built for longevity? Will they last forever?

Bill Craggs: They won't last forever. The population we treat grows. So generally, we tell the patient that we can expect about a year out of a brace, and that's dependent on how fast they grow. Sometimes it's almost two years, sometimes it's six or eight months.

Amanda Wilde (Host): Well, that leads into my next question for Dr. Ghazi. How long do you wear a brace?

Dr John Ghazi: Usually, when we treat patients with braces for scoliosis, we're doing it in patients who still have a significant amount of growth remaining. So, we can really prescribe a brace almost at any age. But typically, patients who are diagnosed with adolescent idiopathic scoliosis are being diagnosed right around their adolescent growth spurt, sometimes around the age between 10 and 12. And in those cases, the brace usually needs to be worn until they're done growing, and that usually means around age 14 for girls and around age 16 for boys.

Amanda Wilde (Host): So that might mean they'll be fitted for braces throughout those years as they continue to grow.

Dr John Ghazi: Correct. As patients grow, we have to sometimes make minor adjustments to braces. But after a certain point, a new brace needs to be made in order to get a good fit.

Amanda Wilde (Host): So Dr. Ghazi, do you find that children who get a brace also need surgery later?

Dr John Ghazi: So hopefully not. Our main goal of bracing is usually in a patient that we're trying to avoid surgery altogether. So, there's actually a good study in the New England Journal of Medicine in 2013 that randomized certain patients between wearing a brace to prevent curve progression to surgical magnitude. And they found that in patients who were given a brace, 75% of the time, those patients did not require surgery for their scoliosis. Whereas patients who did not get treated with a brace ended up needing surgery about 60% of the time.

Amanda Wilde (Host): Interesting. So we know that helps avoid surgery in some cases. Bill, what about wearing a brace at school or in sports? You know, the fact of moving around, especially with physical activity. Does that affect anything in terms of the wearing of a spine brace?

Bill Craggs: Generally, just for in-school wear, there shouldn't really be an issue with wearing the brace. Obviously, when you move to more active activities, you know, sports, stuff like that, generally we like the trade off of exercise and athletics, so generally it's removed for most sports. It kind of depends on what it is. And we talk to the patients individually about what activities they're involved in. Gym class, for instance, if all you're doing is playing kickball or something like that in gym, do you need to take the brace off really for that? Because taking it off and getting it back on properly in school and that can present some problems. So, we kind of individualize that based on what the activities of the child are.

Amanda Wilde (Host): This all really helps with what to watch for and what to expect. Is there anything else that you want parents and children to know about spine braces?

Dr John Ghazi: I think another important point to make is that when we do decide to treat a child with scoliosis in a brace, we know that there's sort of a benefit to a longer amount of time in the brace. So, in that study that I mentioned earlier, in addition to finding that brace treatment helped prevent surgery, they also found added benefit with more hours during the day in the brace. So if children wore a brace for less than six hours in a day, they basically had no effect of that brace. It basically gave them no benefit in terms of avoiding surgery. And we know that the longer a brace is worn, the more likely we are to prevent progression of that curve. So, every case is different in terms of the size of a curve and the patient's age, but typically we're recommending around 18 to 22 hours per day in the brace.

Bill Craggs: Building on that topic, when we fit a patient with their initial brace, we spend a lot of time discussing wear time, weaning into the brace and the importance of being compliant with the brace on, pointing out that exactly what Dr. Ghazi said, the brace doesn't work if it's not on. There's just no telepathic bracing going on with it, and it's committing to the process and putting in your time with it and making it part of your daily activities in your life and following the program with that.

Amanda Wilde (Host): Yeah. So sort of accepting this as a journey that you're on, and you have to follow those rules to get to the goal.

Bill Craggs: Exactly.

Amanda Wilde (Host): Well, Bill Craggs, Dr. John Ghazi, thank you for your good work and thank you for sharing your expertise today.

Dr John Ghazi: Yeah, thanks for having us.

Bill Craggs: You're welcome.

Amanda Wilde (Host): Learn more about the most amazing care for children at shrinerschildren.org. This has been Pediatric Specialty Care Spotlight with Shriner's Children's Chicago. Thanks so much for listening. I'm Amanda Wilde, and we'll talk next time.