title: A comparative study of TLSO, Charleston, and Milwaukee braces for idiopathic scoliosis.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  To determine which of TLSO, Charleston, or Milwaukee bracing best prevents curve progression and surgery in adolescent idiopathic scoliosis.
  
  
  BACKGROUND
  Bracing has been shown to prevent curve progression in idiopathic scoliosis, when compared with no treatment. However, there is little literature available comparing the effectiveness of different brace designs.
  
  
  METHODS
  One hundred seventy patients who completed brace treatment for adolescent idiopathic scoliosis between 1988 and 1995 were studied. Forty-five thoracolumbosacral orthoses, 95 Charleston braces, and 35 Milwaukee braces were used. Thoracolumbosacral orthoses and Charleston braces were used on comparable curves, whereas Milwaukee braces were used in a subgroup in which the other brace designs were considered inappropriate. Evaluated were the absolute increase in curve severity, the percentage of curves that progressed beyond 6 degrees and 10 degrees thresholds, and the percentage of patients who underwent surgery.
  
  
  RESULTS
  Age, Risser stage, curve size, and time braced and observed did not differ among groups. Mean progression of the curve during bracing was 1.1 degrees with thoracolumbosacral orthosis, 6.5 degrees with the Charleston brace, and 6.3 degrees with the Milwaukee brace (P = 0.012; analysis of variance). Proportion of patients with more than 10 degrees of curve progression was 14% with thoracolumbosacral orthosis, 28% with the Charleston brace, and 43% with the Milwaukee brace (P = 0.017; chi-square). The proportion of patients who underwent surgery was 18% with thoracolumbosacral orthosis, 31% with the Charleston brace, and 23% with the Milwaukee brace (P = 0.26; chi-square).
  
  
  CONCLUSIONS
  The thoracolumbosacral orthosis was superior at preventing curve progression in adolescent idiopathic scoliosis.
authors.affiliation: Division of Orthopaedics, University of Ottawa, Children's Hospital of Eastern Ontario, Canada.
authors.forename: A
authors.initials: A
authors.lastname: Howard
authors.forename: J G
authors.initials: JG
authors.lastname: Wright
authors.forename: D
authors.initials: D
authors.lastname: Hedden
mesh_terms: D000293:Adolescent; D001915:Braces; D002648:Child; D015331:Cohort Studies; D018450:Disease Progression; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012600:Scoliosis / Q000517:prevention & control / Q000628:therapy*