Milwaukee brace

The Milwaukee brace (also known as a Cervico-Thoraco-Lumbo-Sacral Orthosis or CTLSO) is a correctional back/body brace to correct for scoliosis, kyphosis, or any number of congenital spine deformities. It is the most subtle of braces, and the most modern and effective treatment for moderate to severe scoliosis.

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The Milwaukee brace is one of the best-known types of underarm braces used by orthopedic physicians today. It was originally designed by Blount and Schmidt in 1946 for postoperative care when surgery required long periods of postoperative immobilization.

The Milwaukee brace is one of the two main types of braces used to treat the lateral curve of the spine in scoliosis, and this brace can be worn to correct any curve in the spine.

The brace can be custom made (by moulding plaster over the patients body) or can be made from a pre-fabricated mold.

The brace must be selected for the specific curve problem and fitted to each patient. This consisted of a plaster/moulded pelvic girdle attached to metal rods extending up to the shoulders where it attached to what would be described as a metal structure with a chin support (sometimes worn with a mouth guard to stop dental deformities) and supports to the back of the head. The brace is then extended, thus pushing both the head and the pelvis apart straightening the spine. In addition to this pressure pads (on the patients abdomen sides) are fitted, to pull the spine to the corrected position.

Today when a growing adolescent is diagnosed with progressive idiopathic scoliosis and the curve is between 25 and 40 degrees, the physician may prescribe the wearing of such a restrictive brace to keep the curve from worsening. Depending on the severity of the curve, the curve pattern, and the amount of growth remaining, the doctor may not wait to document progression but will prescribe bracing on the initial visit.

Compliance on the patient's part in wearing the brace according to the schedule is crucial. Several detailed studies have shown the importance that the mother's attitude has on the child's perception of her own problem and acceptance of treatment.

While no one would suggest that adapting physically and psychologically to bracing is easy for children and teenagers, studies show that after an initial adjustment period, children who are braced live very normal lives. Patients can then engage in appropriate activities, including sports (with some limitations), and that they have good psychosocial adjustment no matter which brace they wear.

As noted above, to have the intended effect (to keep a curve from getting worse), the brace must be worn every day for the full number of hours prescribed by the doctor. Generally almost 24 hours a day is required. Patients can be braced at any age, and should be as soon as the scoliosis or spinal problem has been diagnosed. Most patients will wear their Milwaukee brace from late childhood (age 8 or 9) until late teens (16 or 17 years). Most patients adapt quickly to wearing the brace and the results are typically satisfactory.

In some cases the physicians will prescribe bracing and traction. In these cases the patient will be braced for three months, followed by four weeks in a spinal traction unit. This process may be repeated over a number of years until the desired effect is achieved.

The other main type of brace for scoliosis is called a thoracolumbosacral orthosis (TLSO).