Providence brace

The Providence brace is among the treatments prescribed to slow or stop further curvature of the spine as scoliosis patients naturally age and grow.^[1] While in use, the brace brings the spine closer to the midline or even further by applying both lateral and rotational pressure on the patient's body.^[2][3] The brace applies pressure at three points on the body while the patient is in the supine position, which itself plays a significant part in correcting the coronal plane curvature of the spine.^[4]

The brace is worn for at least eight hours at night and during sleep as it significantly limits mobility while in use.^[2] The brace is indicated for adolescent patients with curves of less 35°.^[2][3] A recent study indicates that the brace is also effective for curvatures up to 45°.^[5] When used on appropriate patients, Providence brace has been shown to have a comparable efficacy as traditional scoliosis orthoses (such as the Boston brace) that require full-time use.^[3][6] Studies report that 50% to 75% of patients show further curve progression of only 5° or less, including when examined two years after stopping use of the brace.^[7] A 2019 study also reported that, if an in-brace correction of more than 70% is achieved, the Providence brace was successful in preventing curve progression in 89% of compliant patients.^[5]

In 1992, Charles d'Amato and Barry McCoy created a board on which scoliosis patients can be positioned in a way that corrected the curvature of their spine.^[6] Developed at Hasbro Children's Hospital in Providence, Rhode Island, the device allowed patients to lie on their back with little discomfort during medical imaging.^[8] D'Amato and McCoy applied the same principles to create a wearable brace for nocturnal use by adolescent patients at home.^[6] The Providence brace gets its name from the city where it was developed like its predecessors such as the Milwaukee brace, the Boston brace, the Wilmington brace, and Charleston brace.^[1]

The Providence brace is designed and custom fitted using a specialized measuring board and a digital model of the patient's body, accompanied by X-rays of the patient's spinal deformity.^[1][9] A CAD/CAM model is used to make the brace out of copoly plastic which is then modified to ensure optimal correction of the spinal curvature.^[3] The brace is manufactured by Spinal Technology, Inc., based in West Yarmouth, Massachusetts, and marketed under the name Providence Nocturnal Scoliosis System.^[6][10]