Idiopathic Scoliosis

ANALYSIS OF CURVE PATTERNS AND THE PRELIMINARY RESULTS OF MILWAUKEE- BRACE TREATMENT IN ONE HUNDRED SIXTY-NINE PATIENTS

¹ From the Department of Orthopedic Surgery, University of Minnesota Health Science Center, Minneapolis

A retrospective study is reported of 228 major idiopathic curves in 169 patients who had either completed Milwaukee-brace treatment (132) or were wearing the brace at night only during the weaning process (thirty-seven). The data collected and analyzed included the history, initial and final physical findings, roentgenograms of the spinal deformity, and the curves as determined at different evaluation times during and after treatment.

The findings and conclusions were as follows:

1. Major curves occurred in three distinct areas: high thoracic (seventh cervical to the seventh thoracic vertebra), thoracic (third thoracic to the third lumbar vertebra), and lumbar (tenth thoracic to the fifth lumbar vertebra).

2. The median total brace-wearing time was 34.4 months.

3. The best correction was obtained within the first twenty-five months in 97 per cent and within two and one-half years in all patients.

4. The high thoracic curves gave the poorest response; the thoracic and lumbar, the best.

5. The median loss of correction after removal of the brace was 1 per cent in thoracic curves and 5 per cent in lumbar curves.

6. The best response to brace treatment occurred when treatment was begun before the iliac epiphyses were capped.

7. Longer curves corrected best.

8. Only one curve of less than 40 degrees at the start of brace treatment was surgically corrected (the patient was uncooperative).

9. Since small curves treated in a Milwaukee brace may show-little or no final correction, these curves lower the percentage of correction at end-result evaluation. Nonetheless, the correction in these curves should be classified as satisfactory because the curves were not allowed to progress.

10. Some of the larger (45 to 50 degrees) double major curves of the right thoracic left lumbar variety showed no roentgenographic improvement but still demonstrated substantial cosmetic improvement with better balance and lessening of the rib prominence. Thus, the improvement produced by the brace is not necessarily demonstrable in a quantitative fashion. Factors 9 and 10 were not considered in this analysis.

11. Severe deformities in some young patients were kept from progressing or were even improved so that necessary surgery could be safely delayed until a more desirable age for operation was reached.

12. The best results were obtained when there was full cooperation by the patient.

13. Study of a greater number of patients who have completed their Milwaukeebrace treatment program and have been followed long enough to evaluate the final result is necessary.

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