Scoliosis - Braces

Types of Braces

Milwaukee Brace. A full torso brace called the Milwaukee brace was the standard treatment until a decade ago. It is still used particularly for high curves.

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The device contains a wide flat bar in front and two smaller ones in back. These bars attach to a ring around the neck that has rests for the chin and back of the head. One study determined that lying on the chest when the brace is worn is the best position for correcting the curve. Some researchers then suggested that increasing the tension on the chest straps might add benefit. The brace is also periodically adjusted for growth.

The brace needs to be worn 23 hours a day, with relief during bathing and exercise only. Compliance is a major problem. In one study, only 15% of patients wore the Milwaukee brace as directed. It is a particularly difficult brace to endure wearing; one woman who had worn it for seven years during adolescence remembered herself as being invisible at school, ignored and shunned by other children.

The Boston and TLSO Braces. Molded braces called thoracolumbar-sacral orthoses (TLSOs), most often the Boston brace, come up to beneath the underarms and can be fitted to be worn close to the skin so that they don't show under clothes. It appears to be effective for mid-back and lower curves. In one study treatment was judged successful in 61% of adolescents who wore Boston braces, and success correlated with wearing the brace more than 18 hours a day. Wearing them for 16 hours a day may still be beneficial, although the risk for curve progression is significantly higher the less time the braces are worn. These braces have problems; they are hot, reduce lung capacity by nearly 20%, and cause mild, temporary changes in kidney function.

The Charleston Bending Brace. The Charleston Bending Brace is worn only at night. Some physicians question its value, although it appears to be suitable for small, flexible curves. In 2002 study, it was equally effective as the Boston brace. Other studies have reported success rates of 56% to 66% in patients who wore the brace as directed. Still, more than 10% of the patients using either brace eventually needed surgery.

Additional Braces in Development. New braces are being developed in an attempt to improve compliance and results. Some examples are the following:

The Providence brace is a computer-fitted device that is worn only at night. It is specifically designed for the individual curvature abnormalities and early studies are showing promise.
A bracing method called the SpineCor uses adjustable bands and a cotton vest that allows flexibility. A 2003 study reported that after two years, the brace corrected the curve by 5 degrees in more than half the patients, 38% were stabilized, and only 7% had curvature that worsened by more than 5 degrees. A recent prospective trial of 24 girls with idiopathic scoliosis compared the SpineCor with a TLSO-type brace. The study indicated that the SpineCor did not halt curvature progression associated with idiopathic scoliosis during the pubertal growth spurt whereas the TLSO device did.
The custom fitted TriaC brace, exerts pressure in specific areas of the back to allow greater comfort and flexibility. It may be less conspicuous than some of the older braces.