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The Journal of Bone and Joint Surgery, Vol 76, Issue 8 1207-1221, Copyright © 1994 by Journal of Bone and Joint Surgery, Inc
The Milwaukee brace for the treatment of adolescent idiopathic scoliosis. A review of one thousand and twenty patients
JE Lonstein and RB Winter
Fairview Riverside Hospital, Minneapolis, Minnesota.
We reviewed the medical records and roentgenograms of 1020 patients who had
been managed for adolescent idiopathic scoliosis, between January 1954 and
December 1979, with a Milwaukee brace; we wished to determine whether use
of the brace had effectively altered the natural history of the disease.
The findings were considered with respect to a previous study of 727
children who had had comparable curves and had not initially been managed
with the brace but had been followed for progression of the curve, during
the same time-span as that in the current study. Of those 727 patients, 558
(77 percent) had no progression of the curve. The average age of the 1020
patients at the time that treatment with the brace was begun was thirteen
and one-half years (range, ten to seventeen years). None of the patients
had received any other treatment, and all had been managed only by the
physicians participating in this study. In both the current and the earlier
series, the outcome was considered a failure if the curve had increased 5
degrees or more; in the patients in the current study, who were managed
with the brace, the outcome was also considered a failure if operative
intervention had been needed. Of the 1020 patients in the current series,
229 (22 percent) had operative intervention; this rate was higher in the
patients who had a curve of more than 30 degrees at the time of bracing and
in those who had a Risser sign of 0 or 1. The 791 remaining patients, who
were managed with the brace only, had a mild improvement of 1 to 4 degrees
at the time that use of the brace was discontinued (the difference being
within the margin of error of measurement). With respect to curves of
between 20 and 39 degrees, the rate of failure was lower in the current
series of patients who had been managed with the brace than in the earlier
series of patients who had not been thus managed but had been followed for
progression. Progression of the curve was found to be related to the
pattern and magnitude of the curve; the age of the patient at the time of
presentation; the Risser sign; and, in girls, the menarchal status. We
recommend that immature adolescents who have a curve of more than 25
degrees and a Risser sign of 0 be managed with a brace immediately, rather
than after progression has been documented.
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