There is a long history of braces used to correct scoliosis. In the nineteenth century, devices designed for scoliosis treatment were made from steel, leather and plaster. Today’s era of scoliosis bracing treatment began with the development of the Milwaukee brace by Drs. Blount and Schmidt in Milwaukee, Wisconsin in the late 1940s. Later, lower profile braces were designed such as the Boston, Wilmington, and Charleston brace, which eliminated the cervical component of the Milwaukee and became more cosmetically acceptable. These rigid “under-arm” scoliosis braces became the backbone of today’s scoliosis bracing treatment. Experience has demonstrated that a rigid symmetrical brace will not re-align the spine sufficiently to prevent progression. The most widely used rigid brace is the Boston brace. This is a symmetrical brace to which pads are added to attempt to create an asymmetrical interface with the child. The positioning and size of the pads is a very subjective process, hence results with the Boston Brace vary considerably. As knowledge of force application improved, newer rigid bracing designs evolved around a pre-built asymmetrical shape with corrections built in, the most widely know being the Cheneau brace. However, as most of these asymmetrical braces were hand built, the process was still very subjective. Results varied widely, depending on the skill and experience of the brace maker (orthotist). Most recently, the process of making an asymmetrical designed brace has been computerized as with The LA BraceTM which results in more consistent correction and optimized results. More recently “non-rigid” or soft scoliosis braces, such as Spine-Cor TM, have been designed to challenge the principles of rigid scoliosis braces. Although, new studies indicate that these soft scoliosis braces are much less effective and the community is returning to the sound proven principles of the asymmetrical “rigid” scoliosis brace.
As a result of the many studies done on bracing, we can conclude that brace treatment is effective if done well. These studies also indicate that the more the curve is reduced while in the orthosis, the better the outcome will be. We call this reduction “in-brace correction”.
Scoliosis bracing was traditionally provided by orthotists skilled particularly in the art. The orthotist would design, make braces, and adjust braces under close guidance of the orthopedist. At each follow-up visit, the orthopedist and orthotist would determine the modifications needed to maximize effectiveness during growth. The last few decades has seen significant advancement in the clinical education of orthotists, allowing them to often take a lead role in the bracing of scoliosis. With the development of managed care and the de-centralization of scoliosis management, many more general practice orthotists provide scoliosis braces for patients amongst their busy schedules. The resulting mean number of scoliosis patients seen by orthotists has been reduced, furthermore the resulting mean experience level of orthotists providing scoliosis bracing has been reduced. To ensure the best possible results, it is important that a prospective new scoliosis brace wearer research their orthotic provider to ensure they are seeing a scoliosis specialist orthotist and not a general practice orthotist. Ask for a scoliosis specific resume indicating the numbers of patients typically seen and written proof of their outcomes.
The Milwaukee brace includes a pelvic girdle with steel bars extending up to a neck ring. It is very uncosmetic and has poor compliance.
The Boston brace is still the most commonly used brace in the US. It is symmetrical, custom molded or modular and includes “correction” pads. The resulting brace is typically very tight and very thick.
The Charleston brace is a “bending” brace that is worn during the night time only. It aims to fully correct the curve by forcing the spine into an overly compensated (bent) alignment. Studies however have shown that Night-Time only bracing is less effective than Full-Time Bracing.
This brace has gained much publicity and significant adoption in the last few years as they market and advertise it as a soft, comfortable, flexible brace which obviously sounds appealing. However comparisons of results show it to be much less effective than a well designed rigid brace.
Cheneau braces are often considered the “Gold standard” for scoliosis bracing. However they are still subject to considerable variability in their utilization dependent on the skill and experience of the orthotist. The L.A. BraceTM represents an advanced form of Cheneau brace utilizing sophisticated algorithms and advanced CAD modeling to ensure effective and consistent correction.
Brace Effectiveness Comparisons
Successful treatment is considered the prevention of curve progression of 6 degrees or greater. The percentage probability of success for different bracing systems is reported in scientific journals as follows:
Weiss in 2005 compared the Cheneau brace to Spine-CorTM and notes patient with the Spine-CorTM averaged almost 10 degrees of progression while patients with the Cheneau brace average 0 degrees of Progression.