Boston Brace Research Articles

The effect of time on qualitative compliance in brace treatment for AIS

Brace treatment is the most commonly used non-surgical treatment method for adolescent idiopathic scoliosis (AIS). This study is to determine the force changes exerted by a brace over time during both day and night-time wear and to explore correlations between force changes to bracing outcomes. Twenty subjects (three male, 17 female) diagnosed with idiopathic scoliosis who had worn their braces for six months participated into this study. However, due to non-continuous brace wear and exclusion of subjects with large curves (Cobb angle >40 degrees), only nine subjects were included into the day-time analysis and 11 subjects were included into night-time analysis. All subjects used a load monitor system from four days up to 14 days with Boston braces. Cobb angle measurements were taken at initiation of brace treatment as well as after weaning upon completion of the treatment. After the monitoring period, the data was extracted and analyzed. Forces were compared between hours 1, 2, and 5 for the day and night groups, and the correlation of force changes to bracing outcomes were analyzed. In daytime wear, a significant decrease in force over time was found. Most of the decrease occurred within hours 1 and 2 of brace wear. There was no significant decrease during night wear. There were no significant correlations between force decline and outcome.

Shape Modification of the Boston Brace Using a Finite-Element Method With Topology Optimization

Using a finite-element (FE) method to reshape the Boston brace, and evaluating the correction effect of the modified Boston brace in terms of Cobb angle. This study aimed to reduce the weight of the Boston brace using a FE method with topology optimization. The Boston brace is widely used to correct an abnormal spinal curve in adolescent idiopathic scoliosis. However, patients wearing the brace usually complain about discomfort caused by its bulkiness. An FE model of a traditional Boston brace was constructed using the software ANSYS 9.0. The loading condition was taken from an X-sensor measuring contact pressures between torso and brace. Topology optimization was conducted to modify the Boston brace. Three patients wearing a traditional brace and then the modified brace were examined in terms of Cobb angle. For the patient with King Type III scoliosis, this modified brace was able to offer the same correction effect as the traditional brace, but the modified brace was lighter by about 12.4%, with the potential to be up to 18% lighter. Based on the traditional Boston brace, this FE model, combined with topology optimization, can effectively estimate redundant material distribution and accordingly custom-design a lighter brace without any loss of its corrective effect.

Évaluation tridimensionnelle et optimisation du traitement orthopédique de la scoliose idiopathique adolescente

Adolescent idiopathic scoliosis involves complex tridimensional deformities of the spine, rib cage and pelvis. Moderate curves generally are treated using an orthosis. This paper presents different studies performed over the last fifteen years related to the biomechanical evaluation and optimization of the orthopedic treatment of scoliotic deformities. Patient specific 3D models of the spine, pelvis and rib cage are computed from calibrated radiographs, and are used to calculate 2D and 3D clinical indices. The torso shape is acquired using surface topography. With such internal and external 3D models, the efficacy of the most frequently used orthoses can be analyzed and new treatments can be developed. Pressures generated by a brace on the patient's trunk were measured using a flexible matrix of pressure sensors and displayed over the patient's internal geometry in order to analyze the brace efficacy. Patient specific finite element models have been developed, including the osseo-ligamentous structures as well as the muscles, the neuro-control, trunk growth and its adaptation to the stress. These models were used to analyze the effects of the Boston brace. The electro-myographic activity also was measured to analyze the << active >> correction mechanisms. Adjustment techniques and software are used to help the orthotists with real time feedback when the brace is being fabricated and adjusted to the patient. Residual growth potential is also being added to the computer model to simulate the long term effect of a brace. The improvement of the orthotic treatments of scoliotic deformities is very encouraging. The exploitation of such tools is expected to allow reaching optimal treatment personalized to each patient. double dagger.

Long term efficacy of the Boston brace for the treatment of idiopathic scoliosis

Study design Between January 1988 and December 1999, ninety-two children have been managed for juvenile and adolescent IS with a Boston brace. There were eighty-two girls and ten boys with a mean age of thirteen years and four months (range, eight to seventeen years). Most of these young patients were followed up for at least six years after skeletal maturity or until failure of treatment (surgical intervention). The patients had a mean initial Cobb angle of 27 degrees (18–40 degrees) and an apical level between T6 and L2. Fifty-five curves were thoraco-lumbar, while thirty-seven were thoracic.

Role of the Triradiate Cartilage in Predicting Curve Progression in Adolescent Idiopathic Scoliosis

Braces are commonly used to treat progressive adolescent idiopathic scoliosis. Several previous studies have reported a correlation between the success of brace treatment and skeletal maturity markers. These studies have not focused on the status of the triradiate cartilage (TRC) as it relates to successful brace treatment for adolescent idiopathic scoliosis. The authors retrospectively evaluated all patients at their institution from 1990 to 1997 with a diagnosis of adolescent idiopathic scoliosis who were treated in a Boston brace. Sixty-two patients met inclusion criteria. At presentation, the average age was 12.87 years, the average Risser sign was 0.56, and 45% of patients had an open TRC. The average follow-up was 2.92 years. Greater than 5 degrees of progression at discontinuation of bracing was considered a failure. Curves with a closed TRC failed bracing 21% of the time, whereas those with an open TRC failed 54% of the time (P = 0.0069). Those curves with a closed TRC progressed 3.12 degrees on average, whereas curves with an open TRC progressed 6.86 degrees. Curves associated with a closed TRC at initiation of bracing progressed less frequently and to a lesser degree than those associated with an open TRC (P = 0.027). Although the TRC is not an independent predictor of curve stability, it is an additional indicator of skeletal maturity and may prove most useful in patients with otherwise borderline indications for brace treatment.

A Prospective Study of Brace Treatment Versus Observation Alone in Adolescent Idiopathic Scoliosis

The Swedish patients included in the previous SRS brace study were invited to take part in a long-term follow-up. To investigate the rate of scoliosis surgery and progression of curves from baseline as well as after maturity. Brace treatment was shown to be superior to electrical muscle stimulation, as well as observation alone, in the original SRS brace study. Few other studies have shown that brace treatment is effective in the treatment of scoliosis. Of 106 patients, 41 in Malmö (all Boston brace treatment) and 65 in Göteborg (observation alone as the intention to treat), 87% attended the follow-up, including radiography and chart review. All radiographs were (re)measured for curve size (Cobb method) by an unbiased examiner. Searching in the mandatory national database for performed surgery identified patients who had undergone surgery after maturity. The mean follow-up time was 16 years and the mean age at follow-up was 32 years The 2 treatment groups had equal curve size at inclusion. The curve size of patients who were treated with a brace from the start was reduced by 6 degrees during treatment, but the curve size returned to the same level during the follow-up period. No patients who were primarily braced went on to undergo surgery. In patients with observation alone as the intention to treat, 20% were braced during adolescence due to progression and another 10% underwent surgery. Seventy percent were only observed and increased by 6 degrees from inclusion until now. No patients underwent surgery after maturity. Progression was related to premenarchal status. The curves of patients with adolescent idiopathic scoliosis with a moderate or smaller size at maturity did not deteriorate beyond their original curve size at the 16-year follow-up. No patients treated primarily with a brace went on to undergo surgery, whereas 6 patients (10%) in the observation group required surgery during adolescence compared with none after maturity. Curve progression was related to immaturity.

Acute L5 pedicle fracture and contralateral spondylolysis in a 12-year-old boy: a case report

Acute unilateral L5 pedicle fracture associated with a pre-existing contralateral spondylolysis is a rare lesion. We report a case in a non-competitive 12-year-old boy. We present the clinical, radiological and specific management of this rare condition. The clinical and radiological draft of this patient was reviewed. The follow-up was 30 months after fracture healing. Some cases reported in the literature were analyzed and our clinical findings and therapeutic strategy was compared and discussed. Non-operative treatment was done including full-time bracing in a modified Boston brace incorporating one thigh for 3 months. Plain radiographs and computed tomographic (CT)-scan performed at 3 and 6 months showed progressive healing of the pedicle fracture and no modification of the contralateral isthmic spondylolytic lesion. At final follow-up, the patient was asymptomatic and resumed all his activities. In skeletally immature patients, we think that conservative treatment should be considered as a treatment option for this unusual injury.

Preliminary Evaluation of a Computer-Assisted Tool for the Design and Adjustment of Braces in Idiopathic Scoliosis

Prospective and randomized clinical study. To evaluate the correction of the spine obtained using a 3-dimensional visualization software tool developed to assist the design and adjustment of braces compared with the correction obtained with the conventional method in a cohort of subjects with adolescent idiopathic scoliosis (AIS). The optimal design and adjustment of trim lines, pad placement, and areas of relief for the Boston brace system in AIS are currently done using clinical examination and coronal radiographs. Correction of spinal curves in the coronal plane has been achieved with this technique, but 3-dimensional correction has yet to be demonstrated. Forty-eight consecutive subjects with AIS requiring treatment with a Boston brace were prospectively entered in the study. For 24 patients (test group), brace design and adjustment was obtained using the computer-assisted tool combining surface topography, surface pressure measurement, and 3-dimensional reconstructions of the trunk, while design and adjustment for the remaining subjects (control group) was done in the conventional manner. Immediate in-brace correction of the spine at the initial visit was compared in both groups. Both groups were comparable in terms of age, sex, curve type, and average deformity in both the coronal and sagittal planes. The average prebrace thoracic deformity was 35 degrees of Cobb angle, while the average lumbar curve was 32 degrees in the test group and 35 degrees in controls. A statistically and clinically significant improvement in correction of coronal curves and of curves in the plane of maximal deformity was found for both thoracic and lumbar curves in both groups, but the improvement was significantly greater in the test group. The average in-brace correction in the test group was 12 degrees +/- 7 degrees compared with 7 degrees +/- 5 degrees in the control group for thoracic curves, while the average in-brace correction in the test group was 10 degrees +/- 5 degrees compared with 6 degrees +/- 5 degrees in the control group for lumbar curves. Similar average corrections were detected in the plane of maximal deformity. In addition, a significant improvement in the orientation of the plane of maximum deformity from 37 degrees to 23 degrees for lumbar curves was noted only in the test group, indicating that true 3-dimensional correction by the brace was obtained in this group. It is possible to improve the design and adjustment of braces in AIS and to achieve 3-dimensional correction of scoliotic curves with the use of a computer-assisted tool allowing 3-dimensional visualization of the spinal curves and the external shape of the trunk.

Virtual prototyping of a brace design for the correction of scoliotic deformities

Based on a three-dimensional patient-specific finite element model of the spine, rib cage, pelvis and abdomen, a parametric model of a thoraco-lumbo-sacral orthosis (TLSO) was built. Its geometry is custom-fit to the patient. The rigid shell, pads and openings are all represented. The interaction between the trunk and the brace is modeled by a point-to-surface contact interface. During the nonlinear simulation process, the brace is opened, positioned on the patient and strap tension is applied. A TLSO similar to Boston brace system was built for a right-thoracic scoliotic patient. The influences of the trochanter pad and strap tension on the 3-D geometrical corrections and on the forces generated by the brace were evaluated. The role of the trochanter pad as a lever arm is confirmed by the model. The brace induces a reduction of the lordosis and pelvic tilt. The reduction of the frontal curvature is about 20% for a strap tension of 60 N. Axial rotation does not significantly change and rib hump is worsened. By using an explicit brace model and a contact interface, a more realistic simulation of orthotic treatment of scoliosis can be achieved. The stabilization of the brace on the patient can be represented and less restrictive boundary conditions can be applied. This model could be used to study the effect of design parameters on the brace efficiency.

Results of brace treatment of adolescent idiopathic scoliosis in boys compared with girls: a retrospective study of 102 patients treated with the Boston brace

The aim of the study was to compare the results of brace treatment of adolescent idiopathic scoliosis (AIS) in male patients with matched female patients and to assess the effectiveness of bracing of boys in AIS and to discuss the results with published data. Between 1987 and 1995, 51 consecutive male patients with AIS were treated with the Boston brace. The patients were advised to wear the brace 23 h/day. The medical records of all patients were reviewed. Cobb angles and Risser signs were measured before bracing, in brace, at brace discontinuation and at final follow-up. Everyone of 51 male patients was compared with a female patient who was treated by the same method and matched by Risser sign, curve pattern, curve magnitude and duration of treatment and follow-up time. Compliance with brace was noted at every visit. Fourteen boys had worn the brace only during nighttime or occasionally and were considered non-compliant. Only compliant patients with treatment period > 1 year and follow-up > 1 year after treatment were accepted for the analyses of effectiveness of brace treatment and its prognostic factors. Thirty-three boys met these inclusion criteria. Bracing was considered to have a failure if > 5 degrees progression occurred or if surgery was performed. At the final follow-up study progression > 5 degrees was found in 16/51 (31.4%) of male patients. Corresponding figures of female patients were 11/51 (21.6%), respectively. In compliant boys progression > 5 degrees occurred in 6/33 boys compared with 9/33 girls. The association between risk of progression and correction% in brace was statistically significant. The overall results of brace treatment of idiopathic scoliosis in male patients were inferior compared with matched females. One reason for inferior overall results in boys was poor compliance with brace wear. However, brace treatment in AIS may be recommended with the same principles in both genders.

The Use of Dynamic Lycra Orthosis in the Treatment of Scoliosis

Treatment of scoliosis has been under discussion in relation to surgical intervention since the Boston brace was presented by Hall in 1976 (Hall et al. 1976; Watts et al. 1977). The effects of rigid bracing on thoracic skeletal integrity and the possible deformation of ribs due to the high localized pressure due to prolonged wear (Biorthex 1999; Coillard et al. 1999) have been highlighted. The lack of compliance (Houghton et al. 1987) has encouraged clinicians to investigate other options for non-surgical treatment. The Spinecor and Triac bracing systems have been developed as a result of this research; however, both of these orthoses had been designed with idiopathic scoliosis in mind. Little research has been done into the effects of bracing on the neuropathic curve. The use of dynamic Lycra garments in the treatment of neurological scoliosis offers the advantage of deformity correction without the bulk and discomfort of rigid braces. Recent clinical experience has shown that the Lycra suits have a positive effect in the treatment of scoliosis. This study discusses the treatment of a child presenting with a spinal tumour and although not truly of neurological presentation indicates that the garment can be used for the different scoliotic presentations.

Est–il trop tard pour entreprendre un traitement orthopédique pour scoliose idiopathique à Risser 4 ?

Orthopaedic treatment for idiopathic scoliosis in adolescence is indicated with a curve of ≥ 20° and a Risser score ≤ 4, because progression of curve is low with Risser scores > 4. We present the case of a young man with a left lumbar idiopathic scoliosis (T12–L4) with a curve of 10°, which was stable from 13 years (Risser 0) to 16 years old (Risser 4). The scoliosis progressed quickly after a Risser score of 4 was achieved. The man had been wearing a lift on the left foot since he was 13, because of a leg length discrepancy, and had been under clinical and radiological monitoring. When the boy reached 17 years, the scoliosis rapidly progressed, to a curve of 22° and a Risser score of > 4. The scoliosis was effectively treated with a Boston brace. At 20 years, the Risser score was 5, and the left lumbar curve was 13° after discontinuing the use of the brace. To our knowledge, no scientific reference indicates a time limit to orthopaedic treatment for idiopathic adolescent scoliosis. Despite the experts' recommendations, a brace might be indicated with a Risser score ≥ 4 to stop the progression of the curve.

Outcome in adolescent idiopathic scoliosis after brace treatment and surgery assessed by means of the Scoliosis Research Society Instrument 24

A retrospectively designed long-term follow-up study of adolescent idiopathic scoliosis (AIS) patients who had completed treatment, of at least 2 years, by means of brace, surgery, or both brace and surgery. This study is to assess the outcome after treatment for AIS by means of the Scoliosis Research Society Outcome Instrument 24 (SRS 24). One hundred and eighteen AIS patients (99 females and 19 males), treated at the Aarhus University Hospital from January 1, 1987 to December 31, 1997, were investigated with at least 2 years follow-up at the time of receiving a posted self-administered questionnaire. Forty-four patients were treated with Boston brace (B) only, 41 patients had surgery (S), and 33 patients were treated both with brace and surgery (BS). The Cobb angles of the three treatment groups did not differ significantly after completed treatment. The outcome in terms of the total SRS 24 score was not significantly different among the three groups. B patients had a significantly better general (not treatment related) self-image and higher general activity level than the total group of surgically treated patients, while surgically treated patients scored significantly better in post-treatment self-image and satisfaction. Comparing B with BS we found a significantly higher general activity level in B patients, while the BS group had significantly higher satisfaction. There were no significant differences between BS and S patients in any of the domain scores. All treatment groups scored "fair or better" in all domain scores of the SRS 24 questionnaire, except in post-treatment function, where all groups scored worse than "fair". Improvement of appearance by means of surgical correction increases mean scores for post-treatment self-image and post-treatment satisfaction. Double-treatment by brace and surgery does not appear to jeopardize a good final outcome.

Factors determining the final outcome of treatment of idiopathic scoliosis with the Boston brace: a longitudinal study.

This study tries to determine factors influencing the final outcome of treatment of idiopathic scoliosis with the Boston brace and to compare the results with the natural history. One hundred and fifty-one patients, 130 girls and 21 boys, treated between 1982 and 1991, were reviewed. A series of continuous and categorical variables were measured, allowing for the construction of a multiple regression equation. Continuous variables were age at discovery of the curve, time of interval between discovery and treatment and age at the beginning of treatment. Furthermore age of menarche, duration of treatment, duration of weaning and age and time of follow-up were noted. Continuous numerical variables were the Cobb angle, the apical vertebral rotation, and the Risser stage. Categorical variables consisted of the results of a questionnaire and the King's classification of the curve. Good results are achieved in older children, with low Cobb angles and advanced maturity, who are, however, the very ones not expected to progress, as also indicated in studies on natural history. Brace treatment seems not to alter the natural history in general, and especially not in the older child; this is the case from age 12 years and Risser stage 2 onwards. In the younger child, a brace is probably still indicated, because it has been proved that a scoliosis is more prone to progress and that a possible positive result can still not be ruled out, as long as randomized control trials are not conducted.

Factors determining the final outcome of treatment of idiopathic scoliosis with the Boston brace: a longitudinal study

This study tries to determine factors influencing the final outcome of treatment of idiopathic scoliosis with the Boston brace and to compare the results with the natural history. One hundred and fifty-one patients, 130 girls and 21 boys, treated between 1982 and 1991, were reviewed. A series of continuous and categorical variables were measured, allowing for the construction of a multiple regression equation. Continuous variables were age at discovery of the curve, time of interval between discovery and treatment and age at the beginning of treatment. Furthermore age of menarche, duration of treatment, duration of weaning and age and time of follow-up were noted. Continuous numerical variables were the Cobb angle, the apical vertebral rotation, and the Risser stage. Categorical variables consisted of the results of a questionnaire and the King's classification of the curve. Good results are achieved in older children, with low Cobb angles and advanced maturity, who are, however, the very ones not expected to progress, as also indicated in studies on natural history. Brace treatment seems not to alter the natural history in general, and especially not in the older child; this is the case from age 12 years and Risser stage 2 onwards. In the younger child, a brace is probably still indicated, because it has been proved that a scoliosis is more prone to progress and that a possible positive result can still not be ruled out, as long as randomized control trials are not conducted.

Biomechanical modelling of orthotic treatment of the scoliotic spine including a detailed representation of the brace-torso interface.

As part of the development of new modelling tools for the simulation and design of brace treatment of scoliosis, a finite element model of a brace and its interface with the torso was proposed. The model was adapted to represent one scoliotic adolescent girl treated with a Boston brace. The 3D geometry was acquired using multiview radiographs. The model included the osseo-ligamentous structures, thoracic and abdominal soft tissues, brace foam and shell, and brace-torso interface. The simulations consisted of brace opening to include the patient's trunk followed by brace closing. To validate the model, the resulting geometry was compared with the real in-brace geometry, and the resulting contact reaction forces at the brace-torso interface were compared with the equivalent forces calculated from pressure measurements made on the in-brace patient. Differences between coronal equivalent and reaction forces were less than 7N. However, sagittal reaction forces (47N) were computed on the abdomen, whereas negligible equivalent forces were measured. The simulated geometry presented partially reduced coronal Cobb angles (1-4 degrees), over-corrected sagittal Cobb angles and maximum deformation plane (5 degrees), completely corrected coronal shift, and sagittal shift and rib humps that were not corrected. This study demonstrated the feasibility of a new approach that represents the load transfer from the brace to the spine more realistically than does the direct application of forces.

Personalized biomechanical simulations of orthotic treatment in idiopathic scoliosis

Objectives. To analyse patient-specific bracing biomechanics in the treatment of scoliosis. Design. Two complementary computer tools have been developed to quantify the brace action on scoliotic spine from pressure measurements, and to simulate its effect on patient-adapted finite element model. Background. Brace pad forces and brace effect on spine deformities have been reported. However, the brace mechanisms still need to be better understood to obtain more effective treatments. Methods. The 3D geometry of the spine and rib cage of three scoliotic adolescents treated by the Boston brace was obtained using a multiview radiographic reconstruction technique. A personalized biomechanical model was constructed for each patient. Pressures generated by the brace on the thorax were measured using pressure sensors. For each zone with a threshold pressure higher than 30 mm Hg, a total equivalent force was calculated and applied to the corresponding model nodes. Results. The pressure were generally scattered on the overall torso, with the highest pressures measured on five distinct regions: right thoracic, left lumbar, abdominal, right and left sides of the pelvis. The equivalent forces were of 18–73 N. Differences between simulated deformed shapes and real in-brace geometry of the patients were less than 6 and 9.8 mm for the vertebral positions in the coronal and sagittal planes, and 7.7° for the Cobb angles. Conclusion. The results supported the feasibility of such approach to analyse patient-specific bracing biomechanics, which may be useful in the design of more effective braces. Relevance The analysis of bracing biomechanics in the treatment of scoliosis requires the development of biomedical engineering techniques allowing both a personalized evaluation and a design improvement of the treatment. The in-demand benefits of “computer assisted medicine” for the scoliotic patients are an improved brace treatment, prevention from invasive surgery, and an increased quality of life.

Electromyography of scoliotic patients treated with a brace

When a brace is used to correct spinal deviation, patients may seek to ease the discomfort from the pressure exerted by the orthosis by actively recruiting specific trunk muscles. The effect of bracing on trunk electromyography (EMG) has been reported in only one study where a limited number of electrodes were placed mainly in the thoracic region. Our hypothesis was that a multi-electrode mapping of the activity of the thoracic, lumbar, and abdominal trunk muscles would provide a more representative picture of the muscular reaction in response to bracing. With a larger number of EMG measuring sites, the presence of any brace-induced trunk muscle activity should be detected. Therefore, EMG signals of 11 adolescent idiopathic scoliosis patients who had been undergoing Boston brace treatment for 0.7–3 years were collected during four isometric tasks to evaluate the response of trunk muscles in the minutes following the application of the brace. Twenty-two pairs of bipolar electrodes were used to measure the EMG signals of the main superficial trunk muscles during four isometric tasks. EMG signals of trunk muscles were compared in braced and unbraced conditions. Brace-induced increases in EMG activity were significant in 43% of the individual measurements and in three of the four tasks for the group mean values. Increases were greater in the lumbar area, especially on the convex side of the secondary (lumbar) curve. These results thus suggest that immediately following the application of the brace, significant muscular responses can be observed in some patients.

The Impact of Lateral Pads versus Posterolateral Pads in the Management of Idiopathic Scoliosis

The Boston-low profile thoracolumbar sacral orthosis (TLSO) is a common treatment for idiopathic scoliosis (IS). Some have found that the forces applied in the brace are not optimal. For example, hypokyphosis, inherent to IS curves, is sometimes amplified by orthotic treatment. Hypokyphosis is a major concern with IS and it is important to reduce. Proper pad placement is therefore critical in achieving optimal correction in the coronal plane while not accentuating hypokyphosis in the sagittal plane. In correction of the thoracic spine, pads are placed either laterally or posterolaterally, pushing against the ribs, thereby correcting lateral curvature of the spine. The decision to use either lateral (L) pads or posterolateral (PL) pads) has raised some discussion. The current study evaluates the pads in the Boston brace in relation to percentage of thoracic correction and degrees increase in hypokyphosis. Charts and x-rays of 38 first-time bracing patients with adolescent and juvenile IS, between the ages of 7 and 15 years, from two ABC-certified orthotists, were examined. As a cross-sectional, retrospective analysis, it was hypothesized that the PL pads would offer no difference in desired coronal plane thoracic correction compared with L pads and that PL pads would create more unwanted increase in hypokyphosis than L pads. Results indicate that practitioners varied in their preference to pad styles, that there was no difference between pad styles for thoracic scoliosis correction (significant at p < 0.10, but not at p < 0.05), and that the PL pad induced more hypokyphosis than the L pad (p < 0.10 and p < 0.05). In conclusion, the use of L pads should be considered in the majority of IS cases, with the exception of scoliosis curves with excessive kyphosis. Scoliosis curves that are hyperkyphotic should be treated with a PL pad to induce thoracic extension.

Early Weaning Might Reduce the Psychological Strain of Boston Bracing: a Study of 136 Patients with Adolescent Idiopathic Scoliosis at 3.5 Years after Termination of Brace Treatment

Early Weaning Might Reduce the Psychological Strain of Boston Bracing: a Study of 136 Patients with Adolescent Idiopathic Scoliosis at 3.5 Years after Termination of Brace Treatment