Long-Term Anatomic and Functional Changes in Patients with Adolescent Idiopathic Scoliosis Treated with the Milwaukee Brace

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Abstract
Ninety-five patients from the Gothenburg Scoliosis Data Base were studied. They met the following criteria: (1) adolescent Idiopathic scoliosis, (2) completion of Milwaukee brace treatment before age 20, (3) a minimum follow-up period of 5 years thereafter, (4) minimum age of 22 years at final follow-up examination. Of these, 85 (90%) were examined personally by an independent investigator, Including anteroposterior and lateral full-length spinal roentgenograms. The average length of follow-up was 7.5 years (range, 5–12 yrs). These patients who successfully completed the brace treatment program, in their midtwenties ended up with curves that were of equal size (33° ± 3°) as when the treatment started (30° ± 3°). In the sagittal plane, the spines were normal; none exhibited hypokyphosis (< 20°). Compared with the straight control group and to a previously reported group of operated patients, the brace group functioned at the same level in regard to marriage, child bearing, sports activities, and job performance. Overall back pain was also reported at a normal rate, with low-back pain significantly less frequent than the control group. Ten patients showed an increase of their curves exceeding 5° eight of these had been pregnant multiple times before age 25. None of the patients pregnant after that age increased their curve size. This study demonstrates that those patients who complete a Milwaukee brace treatment for adolescent idiopathic scollosis from a functional and social point of view do very well. Early pregnancy is a significant risk factor for progression after maturity. Neither this study, nor any previously published demonstrates, however, In real scientific terms the effectiveness of the Milwaukee brace. The authors found from their data base that only 69% of those originally fitted with the brace between 1969 and 1974 successfully completed the treatment. Of the remaining 43 patients, 22 came to surgery because of failure, and an additional 21 patients were noncompliers.

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