What orthoses have been shown to be effective for treatment of adolescent idiopathic scoliosis

Orthoses are recommended for adolescent idiopathic scoliosis patients who have curves of 20° to 40° and who are likely to have significant growth remaining. Patients with curves less than 20° are usually observed for progression, whereas those with curves approaching 50° are generally considered for surgical treatment. There is a lower likelihood of successful orthotic treatment in male patients with scoliosis and for patients with significant curves detected prior to age 10. Options for orthotic treatment include:

• Milwaukee brace (Fig. 18-25): Basic components include a custom molded pelvic girdle, one anterior and two posterior uprights extending from the pelvic girdle to a plastic neck ring, corrective pads, straps, and accessories. This brace can be used for all curve types and is the most effective orthosis for curves with an apex above T8. The cosmetic appearance of this brace is a concern to patients and limits compliance

• TLSO (Fig. 18-26): The TLSO encompasses the pelvis and thorax. Curve correction is obtained through placement of corrective pads within the orthosis. This orthosis is effective for treatment of thoracic curves with an apex located below T8, as well as thoracolumbar and lumbar scoliosis. The best known orthosis in this category is the Boston brace

• Charleston brace (Fig. 18-27): The Charleston brace is designed to be worn only at night while the patient is lying down. This permits fabrication of a brace that overcor-rects the curve and creates a mirror image of the curve. For example, a left lumbar curve is treated by designing a brace that creates a right lumbar curve. The relative success of this brace depends on the flexibility of the spine. It is most effective for single curves in the lumbar or thoracolumbar region. It provides a treatment option for patients who are noncompliant with daytime brace use

• SpineCor brace (Fig. 18-28): This novel design is a flexible brace that utilizes fabric pelvic and thoracic harnesses connected by elastic straps. The elastic straps are tightened to provide lateral and rotational corrective forces

Figure 18-25. Milwaukee brace.
Figure 18-26. Thoracolum-bosacral orthosis (Boston).
Figure 18-28. SpineCor brace.

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