Milwaukee brace

The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace used in the treatment of spinal curvatures (such as scoliosis or kyphosis) in children. It is a full-torso brace that extends from the pelvis to the base of the skull. It was originally designed by Blount and Schmidt in 1946 for postoperative care when surgery required long periods of immobilization.

Milwaukee braces are often custom-made over a mold of the patient's torso, but in some cases, it can be made from prefabricated parts. Three bars—two posterior and one anterior—are attached to a pelvic girdle made of leather or plastic, as well as a neck ring. The ring has an anterior throat mold and two posterior occipital pads, which fit behind the patient's head. Lateral pads are strapped to the bars; adjustment of these straps holds the spine in alignment.

This brace is normally used with growing adolescents to hold a 25° to 40° advancing curve although has been used successfully in adults to prevent further collapse or deformity of the spine. The brace is intended to minimize the progression of deformity to an acceptable level, not to completely correct the curvature. If, despite the brace, curve progression beyond 40-50 degrees is evident, surgery may be required.

The Milwaukee brace is often prescribed to be worn 23 hours a day until the patient reaches skeletal maturity and growth ceases. Adults with a collapsing and / or developing spinal curve are advised to wear the brace for a minimum of 20 hours per day.

A related brace is the Boston brace (underarm brace, also known as a thoraco-lumbo-sacral orthosis, or TLSO), which is more commonly used for scoliosis. That brace does not have a neck ring and is more easily concealed under clothing, thus more acceptable to patients. However, it is not suitable for high thoracic or cervical spinal curvatures.

References

Bracing in the 1990s at the National Scoliosis Foundation
Milwaukee Brace information at Cincinnati Children's Hospital Medical Center
Brace Exercises videos at Prof. Bilotta

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