Milwaukee brace

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The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace most often used in the treatment of spinal curvatures (such as scoliosis or kyphosis) in children but also, more rarely, in adults to prevent collapse of the spine and associated pain and deformity. 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.

Milwaukee braces are often custom-made over a mold of the patient's torso, but in some cases, it can be made from prefabricated parts. Three bars—two posterior and one anterior—are attached to a pelvic girdle made of leather or plastic, as well as a neck ring. The ring has an anterior throat mold and two posterior occipital pads, which fit behind the patient's head. Lateral pads are strapped to the bars; adjustment of these straps holds the spine in alignment.

Female adolescent (14 years old) patient wearing a Milwaukee brace - with neck ring and mandible pad showing. Milwaukee brace - with neck ring and mandible pad.jpg
Female adolescent (14 years old) patient wearing a Milwaukee brace - with neck ring and mandible pad showing.

This brace is normally used with growing adolescents to hold a 25° to 40° advancing curve, although it has also been used successfully in adults to prevent further collapse or deformity of the spine. The brace is intended to minimize the progression of deformity to an acceptable level, not to completely correct the curvature. If, despite the brace, curve progression beyond 40-50 degrees is evident, surgery may be required.

The Milwaukee brace is often prescribed to be worn 23 hours a day until the patient reaches skeletal maturity and growth ceases. Adults with a collapsing and/or developing spinal deformity are advised to wear the brace for a minimum of 20 hours per day.

A related brace is the Boston brace (underarm brace, also known as a thoraco-lumbo-sacral orthosis, or TLSO), which is more commonly used for scoliosis. That brace does not have a neck ring and is more easily concealed under clothing, thus more acceptable to patients. However, it is not suitable for high thoracic or cervical spinal curvatures.

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<span class="mw-page-title-main">Kyphosis</span> Medical condition

Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called lordosis. It can result from degenerative disc disease; developmental abnormalities, most commonly Scheuermann's disease; Copenhagen disease, osteoporosis with compression fractures of the vertebra; multiple myeloma; or trauma. A normal thoracic spine extends from the 1st thoracic to the 12th thoracic vertebra and should have a slight kyphotic angle, ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called kyphosis or "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females.

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Grady straps are a specific strapping configuration used in full body spinal immobilization.

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The neuromechanics of idiopathic scoliosis is about the changes in the bones, muscles and joints in cases of spinal deformity consisting of a lateral curvature scoliosis and a rotation of the vertebrae within the curve, that is not explained by either congenital vertebral abnormalities, or neuromuscular disorders such as muscular dystrophy. The idiopathic scoliosis accounts for 80–90% of scoliosis cases. Its pathogenesis is unknown. However, changes in the vestibular system, a lateral shift of the hand representation and abnormal variability of erector spinae motor map location in the motor cortex may be involved in this disease. A short spinal cord and associated nerve tensions has been proposed as a cause and model for idiopathic scoliosis. Besides idiopathic scoliosis being more frequent in certain families, it is suspected to be transmitted via autosomal dominant inheritance. Estrogens could also play a crucial part in the progression of idiopathic scoliosis through their roles in bone formation, growth, maturation and turnover. Finally, collagen, intervertebral disc and muscle abnormalities have been suggested as the cause in idiopathic scoliosis, although these are perhaps results rather than causes.

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The management of scoliosis is complex and is determined primarily by the type of scoliosis encountered: syndromic, congenital, neuromuscular, or idiopathic. Treatment options for idiopathic scoliosis are determined in part by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression. Non-surgical treatment should be pro-active with intervention performed early as "Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish." Treatment options have historically been categorized under the following types:

  1. Observation
  2. Bracing
  3. Specialized physical therapy
  4. Surgery

Katharina Schroth was a German physiotherapist best known for developing the Schroth Method for Scoliosis. She was born in Dresden with scoliosis, and after years of wearing a thoracic brace to treat it, Schroth set out to find other treatment options. She used breathing techniques, pulley systems, and stretching. These techniques became the basis for the Schroth method and were shared among physiotherapy institutions to treat other patients. The first institution, Breathing Orthopedics, opened in 1921 in Meissen. The second institute was in Sobernheim. The Schroth method introduced a new path of treatment and set the precedent for how other related techniques were developed. For this work, Schroth was awarded the Federal Cross of Merit by the Federal Republic of Germany. Her two institutes were passed down to her daughter, Christa Lehnert-Schroth, and later to her grandson, Dr. Hans-Rudolf Weiss, MD. Dr. Weiss now has his practice where he uses modified versions of his grandmother’s techniques to help those with scoliosis today.

The Providence brace is a nighttime spinal orthosis for the treatment of adolescent idiopathic scoliosis (AIS). The brace is used to curb the natural progression of the disease and prevent further curvature of the AIS patient's spine. The Providence brace was developed by Charles d'Amato and Barry McCoy, and is manufactured by Spinal Technology, Inc.

Spinal posture is the position of the spine in the human body. It is debated what the optimal spinal posture is, and whether poor spinal posture causes lower back pain.

<span class="mw-page-title-main">Halo-gravity traction device</span> Device used to treat spinal deformities

Halo-gravity traction (HGT) is a type of traction device utilized to treat spinal deformities such as scoliosis, congenital spine deformities, cervical instability, basilar invagination, and kyphosis. It is used prior to surgical treatment to reduce the difficulty of the following surgery and the need for a more dangerous surgery. The device works by applying weight to the spine in order to stretch and straighten it. Patients are capable of remaining somewhat active using a wheelchair or a walker whilst undergoing treatment. Most of the research suggests that HGT is a safe treatment, and it can even improve patients' nutrition or respiratory functioning. However, some patients may experience side effects such as headaches or neurological complications. The halo device itself was invented in the 1960s by doctors working at the Riancho Los Amigos hospital. Their work was published in a paper entitled "The Halo: A Spinal Skeletal Traction Fixation Device." The clinician Pierre Stagnara utilized the device to develop Halo-Gravity traction.

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