Types of scoliosis braces

There are several types of commonly used scoliosis braces:

1. Thoraco-Lumbo-Sacral-Orthosis (TLSO)
The most common form of a TLSO brace is called the “Boston brace”, and it may be referred to as an “underarm” brace. This brace is fitted to the child’s body and custom molded from plastic. It works by applying three-point pressure to the curvature to prevent its progression. (See Figure 1.)

It can be worn under clothing and is typically not noticeable. The TLSO brace is usually worn 23 hours a day, and it can be taken off to swim, play sports or participate in gym class during the day.

This type of brace is usually prescribed for curves in the lumbar or thoraco-lumbar part of the spine

2. Cervico-Thoraco-Lumbo-Sacral-Orthosis (known as a Milwaukee brace)
The Milwaukee brace is similar to the TLSO described above, but also includes a neck ring held in place by vertical bars attached to the body of the brace.

It is usually worn 23 hours a day, and can be taken off to swim, play sports or participate in gym class during the day.

This type of brace is often prescribed for curves in the thoracic spine.

3. Charleston Bending Brace
This type of brace is also called a “nighttime” brace because it is only worn while sleeping. A Charleston back brace is molded to the patient while they are bent to the side, and thus applies more pressure and bends the child against the curve. This pressure improves the corrective action of the brace. (See Figure 2, 3)

This type of brace is worn only at night while the child is asleep. Patients can go to school and participate in sports normally without their friends even knowing they have scoliosis and wear a brace, avoiding any potential negative stigma.

Many studies have shown that the Charleston Night time brace is as effective as the above-described 23-hour-a-day brace wear.

Curves must be in the 20 to 40 degree range and the apex of the curve needs to be below the level of the shoulder blade for the Charleston brace to be effective.

Case Example
As an example of bracing treatment that was effective for a young patient, please see the attached figures.

The girl in the figures is 12 years old and athletically active in lacrosse, soccer, and basketball throughout the school year. She had a progressive 35-degree scoliosis King Type II curvature, apex toward the right side as measured from T5 to T12 (see Figure 4).

The patient was pre-menarchal and therefore had a lot of spinal growth left. She was an ideal candidate for the Charleston Nighttime brace (see Figure 5) due to the position and degree of the curve in her spine and because the brace would not interfere with her athletic activities. (Note: the TLSO brace can also be removed during the day for athletic activities.)

An X-ray should always be done after custom-making the brace. For this patient, while in the brace the curvature was reduced down to just 5 degrees, proving that it was a worthwhile treatment (see Figure 6).

As a general rule, the Charleston brace will be worn every night for approximately 8 hours until the patient is one year after onset of menarche. The goal of wearing the brace is to prevent the scoliosis from progressing to over 40 degrees and prevent the need for surgery.