The Boston brace is a TLSO with built-in lumbar flexion, that can be worn under clothes. Lumbar flexion is achieved through posterior flattening of the brace and extension of the mold distally to the buttock. Braces with superstructures have a curve apex above T7. Curves with an apex at or below T7 do not require superstructures to immobilize cervical spine movement. Unlike the Milwaukee brace, the Boston brace cannot be adjusted if the patient grows in height. Both braces need to be changed if pelvic size increases.
• A curve of 20-25° with 10° progression over 1 year
• A curve of 25-30° with 5° progression over 1 year
• Skeletally immature patients with a curve of 30° or greater
Problems that are associated with the use of a Boston brace include the following:
• Local discomfort
• Hip flexion contracture
• Trunk weakness
• Increased abdominal pressure
• Skin breakdown
• Accentuation of hypokyphosis in the thoracic spine, above the brace
Certain preventive measures can reduce difficulties that are associated with the use of a Boston brace, including the following:
• A regimen of hip stretches decreases contractures at the hip.
• Exercise to promote active correction in the brace is suggested.
• The presence of thoracic hypokyphosis is a relative contraindication for the use of a Boston brace.
Failure of the Boston brace to correct deformity can occur because of several factors, including the following:
• Curve above T7
• Improper fit
• Poor patient compliance
The Boston brace’s duration of use is determined by several factors, including the following:
• Daily use ranges from 16-23 hours per day.
• Treatment should continue until the patient is at Risser stage IV or V.
• If the curve is greater than 30°, consider continued use for 1-2 years after maturity, because these curves are at risk of progression.
• The Boston brace is as effective without the superstructure as it is with the superstructure in the treatment of curves in which the apex is below T7.
Clinical information that is relevant to the use of the Boston brace includes the following:
Use of a Boston brace is a more effective means of preventing curve progression and avoiding surgery than is the use of a Charleston bending brace.
One study looked at skeletally immature patients with idiopathic scoliosis who were at least age 10 years when a brace was prescribed. In members of this group who had a curve of 36-45º, nearly 43% who used the Boston brace experienced a curve progression of more than 5°, compared with 83% of those using the Charleston bending brace.
The use of a Charleston bending brace is indicated only with lumbar or small thoracolumbar curves; avoid use in thoracic curves.
Radiographs used to evaluate scoliosis in the Boston brace are taken with the patient in a standing position.
Successful outcomes with brace treatment show an in-brace curve reduction of greater than 50%.