A COMPARATIVE-STUDY OF TLSO, CHARLESTON, AND MILWAUKEE BRACES FOR IDIOPATHIC SCOLIOSIS

Study Design. Retrospective cohort study. Objective. To determine whic h to TLSO, Charleston, or Milwaukee bracing best prevents curve progre ssion and surgery in adolescent idiopathic scoliosis. Summary of Backg round Data. Bracing has been shown to prevent curve progression in idi opathic scoliosis, when compared with no treatment. However, there is little literature available comparing the effectiveness of different b race designs. Methods. One hundred seventy patients who completed brac e treatment for adolescent idiopathic scoliosis between 1988 and 1995 were studied. Forty-five thoracolumbosacral orthoses, 95 Charleston br aces, and 35 Milwaukee braces were used. Thoracolumbosacral orthoses a nd Charleston braces were used on comparable curves, whereas Milwaukee braces were used in a subgroup in which the other brace designs were considered inappropriate. Evaluated were the absolute increase in curv e severity, the percentage of curves that progressed beyond 6 degrees and 10 degrees thresholds, and the percentage of patients who underwen t surgery. Results. Age, Risser stage, curve size, and time braced and observed did not differ among groups. mean progression of the curve d uring bracing was 1.1 degrees with thoracolumbosacral orthosis, 6.5 de grees with the Charleston brace, and 6.3 degrees with the Milwaukee br ace (P = 0.012; analysis of variance). Proportion of patients with mor e than 10 degrees of curve progression was 14% with thoracolumbosacral orthosis, 28% with the Charleston brace, and 43% with the Milwaukee b race (P = 0.017; chi-square). the proportion of patients who underwent surgery was 18% with thoracolumbosacral orthosis, 31% with the charle ston brace, and 23% with the Milwaukee brace (P = 0.26; chi-square). C onclusions. The thoracolumbosacral orthosis was superior at preventing curve progression in adolescent idiopathic scoliosis.