The Milwaukee brace is a CTLSO that was originally designed by Blount and Schmidt to help maintain postoperative correction in patients with scoliosis secondary to polio. The brace is designed to stimulate corrective forces in the patient. When the patient has been fitted properly with a brace, the trunk muscles are in constant use; therefore, disuse atrophy does not occur. The brace has an open design, with constant force provided by the plastic pelvic mold. The pelvic portion helps reduce lordosis, derotates the spine, and corrects frontal deformity.
The uprights have localized pads that apply transverse force, which is effective for small curves. The main corrective force is the thoracic pad, which attaches to the 2 posterior uprights and to 1 anterior upright. Discomfort from the thoracic pad creates a righting response to an upright posture. In contrast to the thoracic pads, the lumbar pads play a passive role.
The uprights are perpendicular to the pelvic section, so any leg-length discrepancy should be corrected to level the pelvis. The neck ring is another corrective force and is designed to give longitudinal traction. Jaw deformity is a potential complication of the use of the neck ring. The throat mold, instead of a mandibular mold, allows the use of distractive force without the development of jaw deformity.
As a child grows, the brace length can be adjusted. In addition, pads can be changed to compensate for spinal growth. The brace needs to be changed if pelvic size increases.
• Used for curves in which the apex is above T7.
• Patients with a Risser score of I-II, as well as a curve that is greater than 20-30° and that progresses by 5° over 1 year
• Curves of 30-40°, but not curves of less than 20°.
• Curves of 20-30°, with no year-over-year progression, require observation every 4-6 months.
Duration of Use:
• 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 of the brace for 1-2 years after maturity, because a curve of this magnitude is at risk of progression.
Problems that are associated with the use of a Milwaukee brace include the following:
• Jaw deformity
• Skin breakdown
• Unsightly appearance
• Difficulty with mobility
• Difficulty with transfers
• Increased energy expenditure with ambulation
Failure to correct deformity can be caused by any of the following:
• Poor patient compliance
• Improper fit
• Curves below T7
Keep in mind clinical information regarding the use of the Milwaukee brace, including the following:
• Only 40% of patients with curves of 20-29° progressed with a Milwaukee brace, compared with 68% by natural history without bracing.
• When comparing the Milwaukee brace with the Boston brace (described below), note that curve progression beyond 45° occurred in 31% of patients with the Boston brace and in 62% with the Milwaukee brace.
• Radiographs that are used to evaluate scoliosis in the Milwaukee brace should be taken with the patient in a standing position.
• Successful outcomes with brace treatment show an in-brace curve reduction of greater than 50%.
The Milwaukee brace and a custom-made TLSO can be used to treat Scheuermann Kyphosis in children with pain or to treat pain associated with kyphosis of greater than 60°.