Milwaukee brace
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The Milwaukee Brace, also known as a cervical thoracolumbar sacral orthosis or CTLSO, is a back brace used in the treatment of spinal curvatures such as scoliosis or kyphosis. 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.
The more commonly used brace for scoliosis is a thoracolumbar sacral orthosis (TLSO), or underarm brace. It does not have a neck ring, is more easily concealed under clothing, and therefore more acceptable to patients. However, it cannot control high thoracic or cervical spinal curvatures.
The brace is custom made over a mold of the patient's torso. In simpler cases, it can be made from prefabricated parts. A pelvic girdle of leather or plastic is first constructed. To it are attached two posterior metal upright bars and a single anterior upright. These three bars are connected to a neck ring which has an anterior throat mold and two posterior occipital pads that fit behind the patient's head. Lateral pads, centered on the apices of the patient's curves, are attached to the uprights by straps. Adjustment of these straps holds the spine in alignment.
The brace is normally used with growing adolescents to hold a 25 and 40 degree advancing curve. The brace seldom corrects the curve, but may be able to minimize the progession to an acceptable level. Otherwise, surgery may be required. It is important that the child wear the brace as prescribed, which may mean 23 hours a day for several years. Special exercises to correct the curve are often prescribed and physical activity helps to maintain the torso muscles.
Children need the support and encouragement of parents and medical personnel to adjust to wearing the brace. Most activities are permitted other than contact sports. The goal is a minimal curvature and the avoidance of surgery.
