Use of a new elastic brace to improve pain and Quality of Life in a patient with painful adult scoliosis: a case report

Technical Summary: Use of a New Elastic Brace to Improve Pain and Quality of Life in a Patient with Painful Adult Scoliosis

Problem Statement
Adult scoliosis is a complex, three-dimensional spinal deformity frequently associated with chronic low back pain, postural imbalance, and diminished health-related quality of life. In degenerative cases, intervertebral disc and facet joint degeneration drive progressive deformity and mechanical symptoms. While surgical intervention is indicated for severe deformities or neurological compromise, many patients—particularly older adults or those with comorbidities—are managed conservatively to prioritize pain control and functional preservation. Current orthotic management for adults relies predominantly on rigid or semi-rigid devices, which often suffer from poor patient tolerance and low adherence. Although elastic orthoses offer the potential for dynamic postural support with greater comfort, controlled evidence regarding their efficacy in the adult population remains limited.

Methodology
This study presents a single case report of a 66-year-old woman with a long-standing thoracolumbar scoliosis (diagnosed in adolescence) presenting with chronic mechanical low back pain exacerbated by prolonged seated work and forward flexion. The patient exhibited a left thoracolumbar curve (Cobb angle 76°) and a right thoracic curve (66°), with reduced lumbar lordosis and anterior trunk imbalance, but no neurological deficits requiring immediate surgery.

The intervention involved a multimodal conservative program comprising:

1. Custom Elastic Orthosis (B.E.L.T.): A Biomechanical Elastic Lumbo-Thoracic support device was custom-fitted. Unlike traditional rigid braces, the B.E.L.T. consists of a high-resistance elastic textile base wrapping the trunk and pelvis, combined with adjustable elastic corrective straps anchored to stable reference points (trochanteric region and upper thoracic cage). The straps were tensioned to apply frontal and derotational forces while preserving mobility. The device was designed to generate supportive forces to assist in managing postural collapse rather than to provide structural curve correction.
2. Usage Protocol: The orthosis was prescribed for "as-needed" use, primarily during prolonged seated work and activities provoking pain. Nocturnal use was not advised.
3. Rehabilitation: The brace was integrated with an individualized program of strengthening and motor-control exercises.
4. Data Collection: Clinical outcomes were assessed at baseline, 3 months, and 6 months using the Numeric Rating Scale (NRS), Oswestry Disability Index (ODI), Core Outcome Measures Index (COMI), and SF-36. The patient maintained a daily diary to record wearing time and pain perception. Radiographic follow-up was not scheduled, as the device's purpose was functional, not structural.

Key Contributions

• Application of a Novel Device: This report details the clinical application of the B.E.L.T., an evolution of a previously developed prototype, specifically for an adult with painful degenerative scoliosis.
• Patient-Centered Approach: It demonstrates a protocol where a custom elastic orthosis is used selectively during symptomatic activities, integrated with active rehabilitation, rather than as a continuous immobilization tool.
• Feasibility and Tolerability: The study documents the practical implementation of measuring, fitting, and adjusting an elastic brace in an adult patient, highlighting the importance of iterative adjustments to optimize comfort and corrective effect.

Results
Over a six-month period, the patient demonstrated clinically meaningful improvements:

• Clinical Scores: Assessments using NRS, ODI, COMI, and SF-36 indicated reductions in pain and disability, alongside improvements in quality of life.
• Compliance and Tolerability: Self-reported compliance was good, with an average usage of approximately four hours per day, typically during morning seated work. The patient reported high tolerability with no significant adverse events (e.g., skin breakdown or persistent pressure-related pain).
• Patient Perspective: The patient reported decreased pain during work hours, improved tolerance for prolonged seated tasks, and greater confidence in daily activities. She noted the ease of application and the ability to use the device selectively as key factors in her satisfaction.

Significance and Claims
The authors conclude that a custom elastic orthosis like the B.E.L.T. may represent a valid non-invasive conservative option for symptomatic control and functional support in painful adult scoliosis. The device functioned as a dynamic supportive adjunct, potentially reducing mechanical stress on pain-generating structures and improving postural alignment during loading.

However, the paper maintains a modest stance regarding its claims. The authors explicitly state that:

• The findings are based on a single case and lack a control condition, making them subject to placebo effects and regression to the mean.
• The device is not designed for structural curve correction, and radiographic changes were not assessed.
• Controlled studies on larger samples are necessary to confirm efficacy, define optimal usage protocols, and identify which patient subgroups are most likely to respond favorably.

The authors suggest that elastic orthoses may serve as a "bridge" to facilitate participation in exercise programs by reducing pain and improving perceived stability, offering a compromise between mechanical support and user comfort. They emphasize that future research should include randomized controlled trials comparing elastic orthoses with rigid braces and exercise-only interventions, incorporating both patient-reported outcomes and objective biomechanical assessments.