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Scoliosis Bracing
Charleston Night Brace
A surgeon's overview of the Charleston bending brace — a night-time brace that holds the spine in a strong side-bend, and what the evidence shows.
The Charleston bending brace is a night-time scoliosis brace built on a distinctive idea: it holds the spine bent firmly towards the convexity of the curve, over-correcting it while the patient sleeps. As a spinal surgeon I prescribe braces and monitor the spine; the fabrication and fitting are the work of a specialist orthotist. This page explains what the Charleston brace is, how its bending principle works, and what the evidence shows.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What the Charleston bending brace is
The Charleston bending brace is a night-time thoracolumbosacral orthosis that is moulded with the patient bent to the side, into the convexity of the curve. This produces a strong over-correction that would be impossible to stand up in, but is well tolerated lying down for a night's sleep. Like the Providence brace, it is worn only in bed, freeing the young person from any daytime bracing.
How it works
By holding the spine over-corrected in a side-bend overnight, the Charleston brace aims to counteract the progression of a curve during growth. Because the correction is applied in maximal side-bending, the brace is generally best suited to single curves, where one dominant curve can be bent against. It is less suited to double curves, because bending to correct one curve can worsen the other.
Who it is for
The Charleston bending brace is generally considered for growing children with a single curve of mild to moderate size that lends itself to over-correction by side-bending. Its main appeal, like all night braces, is that it removes the daytime burden of bracing, which can greatly help adherence in a self-conscious teenager. Whether it is appropriate is a specialist decision based on the curve pattern, and double or high thoracic curves are usually better served by other approaches.
What the evidence shows
Studies of the Charleston bending brace report good primary in-brace corrections and control of progression in a majority of well-selected single-curve patients. Early and long-term series found that most patients improved or stayed stable, though a minority progressed to the point of needing surgery. Compared with observation, night bracing reduced the proportion of patients progressing to the full-time bracing threshold, although its effect on the eventual need for surgery has been less clear-cut in some studies. Systematic reviews place night-time bracing, including the Charleston approach, as an effective option for suitable single curves, with the recurring caveats that patient selection and curve pattern matter and that double curves respond less well.
What to expect
The brace is custom-moulded in side-bending and fitted by a specialist orthotist, with an in-brace X-ray to confirm the correction. It is worn only at night, reviewed in clinic with periodic X-rays, and continued until skeletal maturity before being withdrawn, with the spine monitored throughout.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and investigations, treatment options, potential risks, expected recovery and outcomes depend upon an individual's diagnosis, symptoms, medical history, examination findings, skeletal maturity, curve pattern and personal circumstances. A brace should be prescribed and monitored by a specialist team and designed and fitted by a qualified orthotist. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —Price CT, et al. Nighttime bracing for AIS with the Charleston bending brace: preliminary report. (PMID 2281373)
- —Nighttime bracing for AIS with the Charleston bending brace: long-term follow-up. (PMID 9591969)
- —Effectiveness of the Charleston bending brace in single-curve idiopathic scoliosis. (PMID 11744860)
- —Evaluation of primary correction with the Charleston bending brace as the sole intervention. (PMC11943595)
- —Nighttime bracing versus observation for early adolescent idiopathic scoliosis. (PMID 24840659 / PMC4141910)
- —The efficacy of night bracing in the treatment of AIS: a systematic review. (PMID 38999227 / PMC11242083)
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