Bracing Scoliosis
History
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 Brace™ 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.
Types of Braces
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”.
Milwaukee Brace
The Milwaukee brace includes a pelvic girdle with steel bars extending up to a neck ring. It is very un-cosmetic and has poor compliance.
Boston Brace
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.
Charleston Brace
The Charleston brace is a “bending” brace that is worn during the night time only. It aims to force the spine into an overly compensated (bent) alignment. Studies however have shown that Night-Time only bracing is less effective than Full-Time Bracing.
Spine-Cor™
The Spine-cor Brace is a soft fabric brace. It was popular in the early 2000’s as it claimed to correct scoliosis in a brace that was easy to tolerate. It is now rarely used as studies have shown it to be very ineffective.
Cheneau Braces
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.
The LA Brace™
The LA Brace™ is a modified Cheneau type brace that has been scientifically redesigned to maximize the biomechanical effectiveness of scoliosis bracing. We identify scoliosis in multiple different patterns and apply the optimum biomechanical correction forces to ensure maximum possible correction and therefore best possible outcomes.
The Orthotist
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.
Brace Effectiveness Comparisons
Successful treatment is considered the prevention of curve progression of 6 degrees or greater. If a curve progresses more than 5 degrees then it is considered to be a failure. Looking at an abundance of evidence, the percentage probability of success for different bracing systems, as reported in various scientific journals can be said to be as follows:
Milwaukee 60-70%
Boston 60-70%
Charleston 50-60%
Spine-Cor 50-60%
Cheneau 80%
LA Brace 90%
Read the 2016 study by the developer of The LA Brace:
Full-Time Idiopathic Scoliosis Bracing with The L.A. Brace™ and Comparative Outcomes by G. Bowman C.O.