A history of bracing for idiopathic scoliosis in North America

Abstract

The care of the patient with scoliosis has a history extending back over two millennia with cast and brace treatment being a relatively recent endeavor, the modern era comprising just over half a century. Much of the previous literature provides a modest overview with emphasis on the history of the operative management. To better understand the current concepts of brace treatment of scoliosis, an appreciation of the history of bracing would be helpful. As such, we review the history of the treatment of scoliosis with an emphasis on modern brace treatment, primarily from a North American perspective. Our review utilizes consideration of historical texts as well as current treatises on the history of scoliosis and includes discussion of brace development with their proponents' rationale for why they work along with an appraisal of their clinical outcomes. We provide an overview of the current standards of care and the braces typically employed toward that standard including: the Milwaukee brace, the Wilmington brace, the Boston brace, the Charleston brace, the Providence brace and the SpineCor brace. Finally, we discuss future trends including improvements in methods of determining the critical period of peak growth velocity in children with scoliosis, the exciting promise of gene markers for progressive scoliosis and "internal bracing" options.

Fig. 1

The Milwaukee brace, a cervicothoracolumosacral orthosis introduced in 1958, was the first of the modern spinal braces. (Reprinted from Blount WP, Schmidt AC, Bidwell RG. Making the Milwaukee brace. J Bone Joint Surg Am. 1958;40:526–528 with permission from Journal of Bone and Joint Surgery, Inc., Needham, MA.)

Fig. 2

A Wilmington brace plaster jacket is molded to a patient placed on a Risser frame.

Fig. 3

The Wilmington brace is a popular thoracolumbosacral orthosis that is custom-molded to the patient.

Fig. 4

The prefabricated Boston brace orthosis is one of the more widely used thoracolumbosacral orthoses in use today. (Photo courtesy of Boston Brace, Inc., Avon, MA. Reprinted with permission.)

Fig. 5

The Charleston nighttime brace relies on side-bending for curve correction. (Photo courtesy of C. Ralph Hooper, Jr., CPO, Charleston Bending Brace Foundation, Charleston, SC. Reprinted with permission.)

Fig. 6

The Providence nighttime brace works through a combination of forces: laterally applied three-point bending and rotational. (Photo courtesy of Spinal Technology, Inc., West Yarmouth, MA. Reprinted with permission.)

Fig. 7

The SpineCor brace is a proposed flexible bracing alternative to standard rigid thoracolumbosacral orthosis braces. (Photo courtesy of Drs. Charles H. Rivard and Christine Coillard. Reprinted with permission.)