No matter what the type of scoliosis, there are three basic approaches to treatment: observation; bracing; and surgery.

Observation

Small curves, particularly those less than 20°, and some larger curves in older children with limited remaining growth, usually can be treated with observation.  The child will be followed with serial exams that occur as frequently as every three months.  X-rays may also be checked at all or some of the visits.  As long as the curve is not getting bigger, no other treatment is required.  However, if during observation the curve is noted to get significantly larger, bracing or surgery may be recommended.

Bracing

Bracing is the only nonoperative intervention that has shown to be at all effective in treating scoliosis.  It is important to understand that the goal of bracing is usually to stop the curve from getting worse, not to make the curve smaller.  Even although the curve will look smaller while the child is in the brace, when the brace comes off the curve will go back to where it started from.  Once bracing has been started, it continues until either the child has stopped growing or the curve has shown it is going to continue to get worse despite use of the brace. 

In some cases, bracing is used to slow progression of the curve in a small child; even when surgery is recognized to be inevitable, waiting until the child is older and bigger often offers many advantages.

There are a variety of braces available, depending on the type and location of the curve. Interestingly, most of these seem to be named after the city in which they were developed.  The most commonly used brace is called the Boston brace.  In this brace is similar to a corset that is made of plastic and phone.  It sits on the pelvis and extends up and around the chest, but stays underneath the arms.  It uses pants to push on the curve which should cause some straightening of the curve and provide some resistance to progression.  It can be worn completely underneath clothing including a T-shirt.  When wearing loose fitting clothing, the brace may not be noticed by other people, although tight fitting clothes will reveal the outlines of the brace.  This brace to be effective needs to be worn 18 to 23 hours a day.

The Charleston bending brace is a modified Boston brace that actually bends the child in the direction opposite of their curve.  Because it is bending the child, it cannot be worn while the child is up and about, like the Boston brace.  Instead, it is designed to be worn for about 12 hours a day while the child is sleeping.  This place was initially developed in the southern part of the United States to accommodate the difficulty and discomfort many children were experiencing wearing the Boston brace outdoors in the hot summers.

The Milwaukee brace was developed to help control head position and four scoliosis curves that occurred very high in the thoracic spine.  This brace extends above the shoulders and around the neck and chin of the child, making it clear to anyone that the child is wearing a brace.  Children frequently refused to wear this type of brace because they were stigmatized at school.  Although this brace is quite effective, it is almost never used any more because of this problem.