Milwaukee Brace Research Articles

A 3D German-designed brace used to treat adolescent idiopathic scoliosis

Introduction Adolescent Idiopathic Scoliosis (AIS) is a condition that affects an otherwise healthy child 10 years of age or older and is the high risk of severe deformity and surgery. Different brace applications include the Milwaukee Brace, Boston Scoliosis Brace, TLSO and others, and the success rates of orthoses vary. With little experience in the use of the Chêneau-type corset, the brace provides an effective means for the active correction of scoliotic spinal deformity.The objective was to demonstrate an outcome with a 3D functional corrective German-designed corset used to treat a patient with AIS in the period from the onset of the curve to the onset of skeletal maturity.Material and methods The medical history of patient S. including anamnestic, clinical and radiological findings recorded 2018 and 2023 when she used a 3D German-designed (3D GD) corset. The corset design was defined as 3CL/B2 according to the Lehnert – Schroth scoliotic classification as modified by Rigo.Results The left-sided thoracolumbar curve of a 9-year-old patient with a Risser sign of 0 and a Cobb angle of 25° at baseline decreased to 12° at the age of 16 years (Risser sign — 5) due to bracing.Discussion The AIS was diagnosed in the patient at the age of 5 years and bracing was initiated at the age of 9. The curve correction using 3D GD brace was based on the principles offered by Chêneau. The patient used the corset for 20 hours per day. The initial brace correction was 90 %. The curve decreased from Cobb angle 25° to 12° over a six-year period of brace treatment with no need for surgery. Three cases with identical outcomes were reported with the use of the Boston and Chêneau braces in AIS.Conclusion The clinical case showed effective use of the 3D GD corset as a new exponent of corsets developed on the principles offered by Chêneau to prevent surgical treatment by the time of skeletal maturity.

Immediate vs Gradual Brace Weaning Protocols in Adolescent Idiopathic Scoliosis

Lack of evidence and consensus for brace weaning protocol in adolescent idiopathic scoliosis (AIS) results in clinicians prescribing gradual weaning in the hope of avoiding curve deterioration after weaning. However, gradual weaning contributes to prolonged brace wear, which can affect spinal stiffness and health-related quality of life (HRQoL). To determine whether gradual weaning results in better curve magnitude and truncal balance maintenance after brace weaning vs immediate brace removal for patients with AIS. This was an open-labeled randomized clinical trial commenced in April 2017 with 24-month follow-up completed in January 2023. Outcome assessors were masked to weaning protocol assigned. The study took place at a territory-wide tertiary scoliosis clinic serving the largest number of referrals in the local population. Patients with AIS ready to wean off of brace wear were eligible (402 were screened; 33 were excluded [15 for <18 hours/day of brace-wear compliance before weaning, 11 were treated with Milwaukee brace, and 7 declined to participate]; and 369 were included), and those who were treated with a custom molded thoracolumbosacral orthosis and had reached skeletal maturity were consecutively recruited. Patients were randomized to gradual weaning protocol (n = 176) with an additional 6 months of nighttime wear before completely stopping or immediate weaning protocol (n = 193) with immediate brace removal at recruitment. Changes in major curve Cobb angle and truncal balance from the time of weaning to 6-month, 12-month, and 24-month follow-up. HRQoL was also assessed using the refined Scoliosis Research Society 22-item and EuroQol 5-dimension questionnaires. A total of 369 patients (mean [SD] age, 14.9 [1.1] years; 304 [83.4%] girls) were randomized with 284 (77.0%) completing 24-month longitudinal follow-up. Immediate and gradual weaning groups had no significant differences in change of major Cobb angle at postweaning 6-month (difference, -0.6°; 95% CI, -1.4 to 0.2; P = .17), 12-month (difference, -0.3°; 95% CI, -1.2 to 0.6; P = .47), and 24-month (difference, -0.3°; 95% CI, -1.2 to 0.7; P = .60) follow-up. The number of curve progression, nonprogression, and rebound cases were comparable (χ22 = 2.123; P = .35). Postweaning changes in truncal balance and HRQoL demonstrated no significant differences between groups. Gradual weaning did not demonstrate superiority to immediate weaning with predefined criteria of Cobb angle and truncal balance maintenance and HRQoL after brace weaning. Gradual and immediate weaning achieved very similar maintenance of brace outcomes in AIS. We therefore recommend the consideration of immediate brace weaning, which aims to benefit patients with earlier time for increased exercises and activity level. ClinicalTrials.gov Identifier: NCT03329716.

Brace-Related Stress and Quality-of-Life Parameters in Adolescents with Idiopathic Scoliosis.

This study investigated brace-related stress, trunk appearance perception, and quality of life in adolescent girls with idiopathic scoliosis who wear the Milwaukee brace for treatment. Fifty-two adolescent girls with idiopathic scoliosis participated in this study. They had been under treatment with Milwaukee brace for at least three months. They filled out four questionnaires, including the revised 22-item Scoliosis Research Society questionnaire (SRS-22r), the Brace Questionnaire (BrQ), the Bad Sobernheim Stress Questionnaire-Brace (BSSQ-Brace), and the Trunk Appearance Perception Scale (TAPS). Twenty participants had high stress levels, and thirty-two had moderate stress levels. The total score and emotional and social function scores of the BrQ were significantly higher in participants with high stress compared to those with moderate stress. There was no significant difference between the two groups in the SRS-22r and TAPS questionnaires scores. However, a high Cobb angle had significantly worsened their perception of trunk appearance. It seems that among quality-of-life parameters, social and emotional functions are more affected by stress level in treating adolescent girls with idiopathic scoliosis with a brace. In addition, patients with high stress levels have a worse perception of their trunk appearance.

Effect of the type of brace on head to pelvis sagittal alignment of adolescents with Scheuermann’s kyphosis

ABSTRACT The aim of this study was to determine the effects of the Milwaukee brace and thoracolumbosacral orthosis (TLSO) on head to pelvis sagittal alignment in adolescents with Scheuermann’s kyphosis (SK). A total of 52 adolescents with SK who were under brace treatment were studied. They underwent biplanar radiography of the head to pelvis (EOS Imaging, Paris, France) before and 6 months after the beginning of bracing. We measured T1 slope, neck tilt (NT), cervical sagittal vertical axis (cSVA), thoracic inlet angle (TIA), C0-C2 lordosis, C2-C7 lordosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA) and T1 spinopelvic inclination (T1SPi). There were no significant differences in baseline values of TIA, PT, SS, PI, SVA, TK, cSVA, NT and T1 slope between the two groups (p > 0.05). There were significant differences between the baseline and final measurements of T1 slope, cSVA, TK, LL, T1SPi and TIA in both groups (p < 0.05). The results imply that brace treatment can significantly affect head to pelvis sagittal parameters of adolescents with SK. However, there are no significant differences in the values of head to pelvis sagittal parameters when comparing short-term effect of TLSO and the Milwaukee brace.

Effect of Milwaukee Brace in Adolescent Idiopathic Scoliosis

Effect of Milwaukee Brace in Adolescent Idiopathic Scoliosis

Stress level and quality of life of adolescents with idiopathic scoliosis during brace treatment.

Objectives This study aimed to evaluate the effect of brace treatment on the stress level and quality of life (QoL) of adolescents with idiopathic scoliosis. Patients and methods A total of 194 adolescent individuals were evaluated in two groups: the adolescent idiopathic scoliosis (AIS) group with 97 patients (20 males, 77 females; mean age: 13.9±1.8 years; range 10 to 18 years) and the control group with 97 age-and sex-matched participants (20 males, 77 females; mean age: 14.3±1.7 years; range 10 to 18 years) with no spinal deformity. The AIS group wore the Milwaukee brace or a thoracolumbosacral orthosis based on the location of the apical vertebra. All participants of the AIS group filled the Persian versions of the revised Scoliosis Research Society 22-item questionnaire (SRS-22r), the eight-item Bad Sobernheim Stress Questionnaire (BSSQ)-Deformity, and BSSQ-Brace. The control group only answered the first 20 items (subtotal items) of the SRS-22r. The brace-related QoL and stress level were assessed based on sex, brace, and deformity types. Results The subtotal score of the SRS-22r in the AIS group was significantly lower than the control group (p<0.001). There was a significant difference between deformity-related stress and brace-related stress (p<0.001). Regarding the type of treatment, there were no significant differences in QoL and stress level between the Milwaukee brace and thoracolumbosacral orthosis groups (p>0.05). Moreover, there was a weak correlation between the BSSQ-Brace and the self-image, mental-health scores, and the total scores of the SRS-22r (r=0.39 to 0.42, p<0.001); the low level of perceived stress was associated with a high level of perceived QoL. Conclusion The stress due to brace treatment can decrease function/activity and self-image of adolescents with idiopathic scoliosis.

Temporomandibular Joint Disorders in Females with Adolescent Idiopathic Scoliosis: Long-Term Effects of Milwaukee Brace Treatment.

Patients with adolescent idiopathic scoliosis (AIS) more frequently suffer dysfunctions of dento-skeletal complex. To our knowledge, no study has ever evaluated the temporomandibular joint disorders (TMD) of AIS patients at least 23 years after the completion of Milwaukee brace treatment. We aimed to provide a complex assessment of TMD and AIS patients treated with a Milwaukee brace, in a minimum 23-year follow-up, using radiological, clinical, and socio-demographical data, and to adapt the TMD Disability Index Questionnaire (TMDQ) and Fonseca’s questionnaire (FQ) to Polish conditions. In total, 42 healthy females and 30 AIS patients with a minimum of 23 years after a completed Milwaukee brace treatment were asked to complete the Polish version of (TMDQ-PL) and (FQ-PL). AIS patients present higher TMD levels than healthy controls. Significant differences exist between TMDQ-PL and FQ-PL (both in total scores and particular sub-sections), and AIS patients. Clinical and radiological factors affected the TMDQ-PL and FQ-PL results. Adult patients with scoliosis treated conservatively present limitations in everyday activities connected with the temporomandibular joint (TMJ). The variety of curve-related factors in a long-term follow-up of wearing the Milwaukee brace influence TMJ.

Wonder Woman

Wonder Woman Constance Adler (bio) There is a scar in the center of my chest. A whitish and shiny round patch, the size of a silver dollar, the scar does not match the surrounding skin. It does not blend with its environment; it cannot not hide. Located just above what we might generously refer to as my "cleavage," this scar marks the place where a hard pad pressed into my skin for the months that I wore a back brace, known as the Milwaukee brace, when I was fourteen years old. Here is a picture of the brace: Imagine a contraption that clasped my head in a metal loop, secured tight against my chin and the back of my skull. Metal posts connected the head restraint to a hard, plastic girdle that encased my pelvis and was locked shut at the back with straps, so tight that it left deep-red indentations in the soft flesh of my backside. Once in place, the whole thing resembled a medieval instrument of torture. I came to think of it as a cage that I carried around with me all the time. It was hideous, and it made me hideous. While I was in the brace, it was impossible for me to move from hips to head. The cage held me in a rock-rigid grasp. I could not sleep curled up in a protective knot, as was my habit, but had to lie on my back like a corpse on a slab. I could not bend or turn side to side or look up or down. I could walk, but it was difficult to eat or talk because my chin kept hitting the metal loop around my head when I opened my mouth. I could not tip [End Page 111] my head to look down to the food on the plate in front of me and had to guess at what I might be forking into my mouth. I could go to school, and spend time with my friends, but I was always caged. I had to wear extra-large clothes to fit over the brace, and its hard unsightly lumps protruded through my clothes instead of the normal soft form of my girl's body. I could not see my own feet or reach down to tie my own shoelaces. If my shoe came untied at school, I had to ask a friend to tie it for me. Some kids asked if I'd been mangled in a car accident. The clinical purpose of the Milwaukee brace was to maintain my girl's body in this unyielding position for a year until my back and shoulders grew accustomed to a center plumb line. Then I'd be released, ideally as a more perfect girl. One day I'll have to find out why Milwaukee gets credit for this instrument of torture. What I can tell you now is that my parents put me into this brace for reasons that were a complete mystery to me. They had threatened me with a back brace if I didn't stand up straight, a threat that I did not take seriously. At the dinner table, my father enforced the posture requirement by hitting the back of my head. Slouching made me ugly, apparently, or less than perfect, which for a girl was a moral stain. But I wasn't paying much attention to threats or perfection. I was a dreamy, distracted child with other things on my mind, far more interesting than my posture. This private realm of my imagination also offered an escape from beatings, so I went there often. When I failed to be mindful of my posture, my parents followed through on the threat. My mother and father presented this back brace to me as a punishment for my willful disobedience. This sounds crazy, I know. Why would anyone do that to their kid just to win a power game? But that was thrust of their argument at the time. My mother was in charge of bringing me to the DuPont Orthopedic Clinic in Delaware. During the course of fitting me for the brace, one of the doctors took photographs of...

The Effect of Brace Treatment on Large Curves of 40° to 55° in Adolescents With Idiopathic Scoliosis Who Have Avoided Surgery: A Retrospective Cohort Study

ObjectiveTo evaluate the effect of Milwaukee brace treatment on adolescents with idiopathic scoliosis (AIS) with large curves (40° to 55°) who refuse to do surgery. MethodsIn this retrospective cohort study, we gathered the clinical records of all adolescents with AIS with an initial curve of 40° to 55°. They had been referred to our center from December 1990 to January 2017. Although they had been advised to do surgery, they had all refused to do it. Their clinical data were recorded, such as sex, age, Risser sign, scoliosis, and kyphosis curve magnitude (at the beginning of brace treatment, weaning time, brace discontinuation, and minimum of 2 years after the treatment). Based on treatment success, the patients were divided into 2 groups: progressed and nonprogressed. ResultsSixty patients with an average initial Cobb angle of 44.93°±4.86° were included. The curve progressed in 57%, stabilized in 25%, and improved in 18% of the patients. In the progressed group (34 patients), 31 patients had undergone surgery. There was no significant association between the age of beginning the brace treatment and the final Cobb angle of nonprogressed group (p>0.05). However, in-brace correction and initial Risser sign had a significant correlation with curve magnitude at the final follow-up (p<0.05). ConclusionBrace treatment seems to be effective in controlling the further curve progression in AIS with 40° and 55° curves. Our results can help physicians make sound decisions about the patients with larger curves who refuse to do surgery.

Hyperlordosis Secondary to Myasthenia Gravis Successfully Treated With Brace-wearing and Lordosis Exercises: A Case Report

Spinal deformities secondary to Myasthenia Gravis (MG) are rarely reported and mainly include scoliosis. In this study, we report a case of hyperlordosis with MG origin, which has not been reported earlier. The patient was a 12-year-old boy who underwent thymectomy at the age of three, and the disease was well-controlled afterward. One year ago, the patient presented with fatigue and severe low back pain associated with walking, while his parents noticed his buttocks jut out more than normal. The radiologic evaluation revealed a hyperlordosis of 100º. The patient was treated with a Milwaukee brace and lordosis exercises. One year after the treatment, an improvement of 27º was observed in the hyperlordosis of the patient. While bracing does not typically treat a neuromuscular deformity, the present case reveals the value of bracing in the treatment of hyperlordosis with MG origin.‎

50 Years Ago in TheJournalofPediatrics: How the Milwaukee Brace Shaped the Treatment of Scoliosis

50 Years Ago in TheJournalofPediatrics: How the Milwaukee Brace Shaped the Treatment of Scoliosis

Scheuermann Kyphosis for dummies

Scheuermann kyphosis debuts in young adolescents and it is defined as a fixed hyperkyphosis &gt;40º Cobb, with associated anterior wedging of vertebral endplates of &gt;5º in three or more adjacent vertebrae. It is thought to be caused by mechanical stress on structurally deficitary vertebral endplates. For its diagnosis, clinical history and plain radiographs are used, but also MRI when there is neurological affection. Treatment depends on the severity of the curve: those &lt;60º can be treated orthopedically with Milwaukee bracing in combination with rehabilitation treatment (stretching or muscle strengthening) and postural hygiene. If &gt;70º, surgical treatment is indicated using a posterior-only approach, as it reduces de apparition of complications when compared with anterior and combined approach. Vertebral osteotomies will be made depending on the DAR. We will use pedicular screws and bars, and transverse hooks to end instrumentation, as we attach distally the SSV and proximally the first kyphotic vertebra, to avoid revision surgery. Among the complications (14%) we find surgical site infection (up to 10%), neurological injury (8%), or pulmonary complications derived from anterior approach (20%)

Brace Compliance, Sex, and Initial Cobb Angle as Predictors of Immediate In-Brace Curve Correction in Adolescents With Scheuermann’s Kyphosis

ABSTRACT INTRODUCTION Bracing is the most effective nonoperative treatment for adolescents with Scheuermann’s kyphosis; however, its outcome is not equal for all patients. The effects of potential predictive parameters for the outcome of bracing have not been well evaluated in the literature. The aim of the study was to investigate the potential prognostic factors that affect in-brace curve correction in adolescents with Scheuermann's kyphosis. MATERIALS AND METHODS In this prospective cohort study, patients with thoracic Scheuermann’s kyphosis treated with the Milwaukee brace with a curve of 55° to 86° were included. The primary prognostic factors for in-brace curve correction, including brace compliance and daily exercise by log book, pad pressure by a modified sphygmomanometer, joint hypermobility by Beighton's scale, patients’ sex, and initial Cobb angle were measured. Analyses considered multiple linear regression and independent sample t-test. RESULTS Nineteen boys (13.74 ± 1.55 years) and 33 girls (13.67 ± 1.61 years) were included in the study. The results of the multiple linear regression analysis showed that the degrees of in-brace curve correction were significantly associated with brace compliance and initial Cobb angle (R 2 = 0.48). The results of the independent t-test showed a significant difference in average curve correction, brace compliance, and in-brace pressure between girls and boys. CONCLUSIONS Results of the current study indicated that the amount of in-brace curve correction is primarily affected by brace compliance and initial Cobb angle. Brace compliance, curve correction, and pad pressure in boys were significantly higher than in girls.

Objective Monitoring of Brace Wearing Time in Adolescents with Scheuermann's Kyphosis.

Study DesignThis was a prospective cohort study.PurposeThis study aimed to evaluate the potential differences between the objective and subjective bracing compliances of adolescents with Scheuermann’s kyphosis.Overview of LiteratureBracing is a well-documented intervention for managing adolescents with progressive thoracic Scheuermann’s kyphosis, and the brace should be worn 23 hours every day. Most research studies that have investigated the efficacy of bracing have assumed that the patients wore the braces as advised or that the bracing time was measured subjectively. This may be one of the reasons for the conflicting reports regarding the efficacy of bracing.MethodsNineteen volunteers (11 girls and 7 boys, 12.89±1.77 years) who were prescribed Milwaukee braces for Scheuermann’s kyphosis were enrolled. Each brace was equipped with a miniature temperature logger to record the actual brace wearing time over a period of 3 weeks. The patients and their families were unaware of the mounted sensor. Each participants and/or parent was provided with a questionnaire to record the number of hours for which the brace was worn each day. In addition, the therapist asked each patient and/or his/her parent about the average number of hours that the brace was worn.Results The compliance rates measured using the temperature logger (16.00±4.90 hours daily) were significantly lower than those reported in the questionnaires (19.52±6.04 hours daily, p<0.001) and the verbal responses (20.21±6.05 hours daily, p<0.001). Moreover, there was no correlation of age, sex, and body mass index with brace compliance.ConclusionsThe braces were worn less often than reported by the patients and/or their parents. Therefore, objective compliance assessments of adolescents with Scheuermann’s kyphosis in a brace are recommended for future studies.

The intra- and inter-observer reliability of interface pressure measurements of the Milwaukee brace in adolescents with hyperkyphosis.

There is a lack of evidence in reliability of the modified sphygmomanometer to measure the brace-interface pad pressure in adolescents with Scheuermann's kyphosis (SK). To evaluate the intra- and inter-observer reliability of modified sphygmomanometer for measuring interface pad pressure in the Milwaukee brace. Two observers measured the pressure of the shoulder and kyphosis pads in Milwaukee brace on 33 adolescents with SK with an average age of 14.67 ± 1.72 years and Cobb angle 64.48∘± 7.53∘. All measurements were obtained in one day. The measurements were done in the inhalation and exhalation of tidal breathing during standing and sitting positions. The intraclass correlation coefficient (ICC), 95% confidence interval (CI), and linear mixed model ANOVA effects were calculated. The intra-observer reliability varied from a good ICC of 0.81 (0.66-0.90) to an excellent of 0.97 (0.95-0.98). The inter-observer reliability also varied from a good ICC of 0.82 (0.67-0.91) to an excellent of 0.96 (0.93-0.98). The linear mixed model ANOVA analysis showed that the rater, position, and breathing had a significant effect on the pad pressure measurements. The modified sphygmomanometer is a reliable tool to measure the pad pressure of the Milwaukee brace for adolescents with SK.

Results of Bracing for Juvenile Idiopathic Scoliosis*

Study DesignRetrospective comparative therapeutic clinical study evaluating the results of bracing for juvenile idiopathic scoliosis (JIS). ObjectivesTo evaluate if bracing has a role in treatment of JIS and, if so, to report its success rate and factors associated with successful bracing. Summary of Background DataPatients with JIS have higher mortality and morbidity in comparison to those with adolescent idiopathic scoliosis (AIS) or general population. Untreated JIS may cause severe cardiorespiratory compromise. MethodsAll children treated at our institute and followed up until either skeletal maturity or surgeries between 1956 and 1999 with JIS were included. Those who had an incomplete set of radiographs or those treated by mere observation were excluded. ResultsOne hundred twenty-five patients, comprising of 93 who were braced as juveniles and 32 who were braced in adolescence, met the inclusion criteria. Fifty-six of them were successfully treated by bracing (32 juveniles and 24 adolescents) and 69 patients needed surgery despite bracing. When final curves greater than 45° were regarded as failure of bracing, the success rate was 41%. The braces used were Milwaukee brace (MB) and thoraco-lumbo-sacral orthosis (TLSO) and no statistically significant difference was found between the two. None of the patients had surgery of any kind during the juvenile phase (ie, at age <10 years). DiscussionThe overall success rate with bracing was 41%. A third of them (ie, 18/56) could be safely weaned prior to skeletal maturity without risking curve progression. The odds of needing a surgery when braced as a juvenile was 2-in-3 (34% success), which fell to almost 1-in-4 for an adolescent (75% success) and was statistically significant (p = .001). Curves with Cobb angle ≤29° when braced progressed to a degree warranting surgery at a lower rate as compared to those ≥30°, this difference was not statistically significant (p = .22). ConclusionBracing obviated the need for surgery during juvenile years in all patients and was a successful delaying strategy.

Long-term effects of conservative treatment of Milwaukee brace on body image and mental health of patients with idiopathic scoliosis.

We aimed to provide a complex assessment of adult females with adolescent idiopathic scoliosis (AIS) after a minimum of 23 years after completed Milwaukee brace treatment. In the present study, a comparison between healthy female and AIS patients’ perception of trunk disfigurement, self-image, mental health, pain level and everyday activity was made. Thirty AIS patients with a mean of 27.77 yrs (SD 3.30) after the treatment were included in the study. The control group consisted of 42 females, matching the age profile of the patient group. Study participants from both groups were examined using the same protocol, except for the radiological evaluation. Patients and healthy controls completed the Polish versions of the Scoliosis Research Society (SRS-22) and Spinal Appearance Questionnaire (SAQ). Patients additionally filled the Bad Sobberheim Stress Questionnaire-Deformity (BSSQ-Deformity) and Bad Sobberheim Stress Questionnaire-Brace (BSSQ-Brace). The study group’s SAQ results differ significantly in regard to the total score and all individual domains, indicating better functioning among healthy controls. Except for the General domain (p = 0.002), among the remaining subscales the study group’s results differed significantly at p<0.001. Considering SRS-22 results, it was revealed that the patient group scored higher, signaling better functioning with reference to pain level (p = 0.016), function/activity (p<0.001) and the total score (p<0.001). The findings add to the complexity of long-term effect evaluations of AIS, particularly amongst females treated with a Milwaukee brace. Long-term results were not conclusive in terms of nonverbal assessment of body image and emotional tension regarding the experiences of brace-wearing. Future patients can be reassured that scoliosis treated conservatively does not negatively affect everyday activity, pain level, childbearing and mental health. Subjects who declared to have psychological problems due to scoliosis had a bigger curve size after treatment and in this study than the other AIS patients.

Back and neck pain and function in females with adolescent idiopathic scoliosis: A follow-up at least 23 years after conservative treatment with a Milwaukee brace.

We aimed to explore the long-term outcomes of back and neck pain and functionality in adult females with adolescent idiopathic scoliosis (AIS), who had been treated with a Milwaukee brace, in a follow-up study a minimum of 23 years after the completion of the treatment, using radiological, clinical and socio-demographical data. Thirty AIS patients (scoliosis group–SG), were included in the study based on an extensive search of Pediatric Orthopedics and Traumatology Clinic charts. All treatments were successfully completed between 1974 and 1990. In all cases, scoliosis had not been detected before the age of 10 and was not combined with any major spinal deformities at the time when the brace treatment was implemented. In those patients, the Risser sign 4 and minimum two years post-menarche was defined as a maturity, after that time the brace treatment was completed. Patients were excluded from the study if they, at the time of the follow-up examinations, suffered from any other disease leading to trunk deformity. Forty patients met the criteria for inclusion, but due to change some personal details, not all of them were contacted. Finally, 30 women returned for a follow-up evaluation. Patients’ follow-up period was mean 27.77 yrs. ± SD 3.30 (range 23–35). Curvature change from the end of the treatment until the present day was mean 9.1 degrees ± SD 7.64 (range 0–27). A control group of 42 healthy females (healthy controls group—HG) matching the age profile of the patient group was randomly selected for comparative purposes.Both SG and HG completed the Polish versions of the Revised Oswestry Lower Back Pain Disability Index (RODI), the Rolland-Morris Questionnaire (RMQ), the Quebec Back Pain Disability Scale (QDS), the Neck Disability Index (NDI) and the Copenhagen Neck Functional Disability Scale (CNFDS). Descriptive statistics were calculated for demographics and baseline questionnaire scores. To determine if the investigated sample sizes are equivalent, the chi-square test was used. The chi-square test was used to compare qualitative features between persons with scoliosis and healthy controls. In addition, a Mann-Whitney test was utilized to compare differences between both groups in regard to quantitative characteristics. To establish relations between quantitative data such as e.g. age, duration of brace application, apical translation, Cobb angle, and questionnaire results, we used Spearman's rank correlation (marked as rS). To determine dependency between quantitative and qualitative characteristics, e.g. between questionnaire numerical data and marital status, place of residence or curve type, ANOVA Kruskal-Wallis test was used. A p<0.05 indicates statistical significance. Statistical calculations were performed by Statistica software. In regards to RODI, RMQ, QDS, NDI and CNFDS (both for total scores and particular sub-sections), statistically significant differences (p <0.001) between both samples were found, indicating higher levels of pain and neck and lower back pain-related disability among persons with scoliosis. Associations exist between RODI and RMQ (rS = 0.76) QDS (rS = 0.70), NDI (rS = 0.69) and CNFDS (rS = 0.60). RMQ was associated with QDS (rS = 0.71) and NDI (rS = 0.69), whereas QDS correlated with NDI (rS = 0.80) and CNFDS (rS = 0.60). NDI was also associated with CNFDS (rS = 0.81). Persons with scoliosis treated in adolescence with a Milwaukee brace display significant restrictions in everyday activities, due to lower back pain (LBP) and neck-related disabilities, compared to healthy controls. In addition, back pain is associated with curve progression in long-term follow-up after conservative treatment. Moreover, LBP-related disability coexists with restrictions experienced due to neck pain.

Measurement of Milwaukee Brace Pad Pressure in Adolescent Round Back Deformity Treatment.

Study DesignIn this prospective study, we measured the pad pressures of the Milwaukee brace in adolescent hyperkyphosis treatment.PurposeWe evaluated the skin-brace interface forces exerted by the main pads of the Milwaukee brace.Overview of LiteratureA fundamental factor associated with brace effectiveness in spinal deformity is pad force adjustment. However, few studies have evaluated the in-brace force magnitude and its effect on curve correction.MethodsInterface forces at four pads of the Milwaukee brace were measured in 73 patients withround back deformity (mean age, 14.04±1.97 years [range, 10–18]; mean initial Cobb angle,67.70°±9.23° [range, 50°–86°]). We used a modified aneroid sphygmomanometer to measure the shoulder and kyphosis pad pressures. Each patient underwent measurement in the standing and sitting positions during inhalation/exhalation.ResultsThe mean pad pressures were significantly higher in the standing than in thesitting position, and significantly higher pressures were observed during inhalation compared toexhalation (p=0.001).There were no statistically significant differences between right and left shoulder pad pressures (p>0.05); however, the pressure differences between the right and left kyphosis pads were statistically significant (p<0.05). In a comparison of corrective forces with bracing for less or more than 6 months, corrective force was larger with bracing for less than 6 months (p=0.02). In the standing position, there were no statistically significant correlations between pad pressures and kyphosis curve correction.ConclusionsIn the sitting position, there was a trend toward lower forces at the skin-brace interface; therefore, brace adjustment in the standing position may be useful and more effective. There was no significant correlation between the magnitude of the pad pressures and the degree of in-brace curve correction.

Successful brace treatment of Scheuermann's kyphosis with different angles.

Background:Scheuermann's disease is regarded as the most common cause of structural hyperkyphosis within adolescents without any proper treatment. It may lead to progressive deformity and back pain which influences patient's quality of life during adolescence and adulthood. Treatment approach to Scheuermann's kyphosis has not been clearly defined due to its different definitions and obscure natural history. The goal of treatment is not only to prevent progression but also to obtain permanent correction. Bracing, especially Milwaukee brace and physiotherapy are two of the common nonoperative treatment modalities. Hence, the present study intended to evaluate the effectiveness of Milwaukee brace on progression control as well as correction of Scheuermann's kyphosis.Materials and Methods:In a retrospective, observational study, all the patients diagnosed with Scheuermann's kyphosis were reviewed in 2003–2013, who were treated by Milwaukee brace at a single center. There was a minimum of 2-year follow-up after completion of bracing, during which clinical and radiological parameters were identified and recorded.Results:The mean angle of kyphosis in these patients at the presentation was 63.24 ± 9.96 and at the end of this study was 36.5° ± 13.4° (P < 0.001). Moreover, mean improved angle in those patients with <75° of kyphosis was 25.26° ± 7.78° and in those with 75° or more than 75° of kyphosis was 26.77° ± 19.76° (P < 0.001).Conclusion:Conservative treatment with Milwaukee brace and physiotherapy was effective in our hand for halting kyphosis progression in 97.5% of Scheuermann's kyphosis, which could be advised for cases up to 90° of kyphosis before skeletal maturity. As a result, a trial of brace treatment could be recommended in patients with severe kyphosis (up to 90°) which can open a new insight in conservative treatment of Scheuermann's kyphosis.