Milwaukee Brace for Adolescent Scoliosis Associated With Long-Term Back Pain

An x-ray on the spine
An x-ray on the spine
Women who were treated as adolescents with a restrictive Milwaukee brace during adolescence may be at higher risk for experiencing low back pain and neck-related disabilities in adulthood.

Women treated with a restrictive Milwaukee brace during adolescence may be at higher risk for low back pain- and neck-related disabilities in adulthood, according to a long-term study published in PLoS One.

Thirty pediatric patients with idiopathic scoliosis — as indicated in Pediatric Orthopedics and Traumatology Clinic charts — and 42 age-matched controls were included in the study. Scoliosis was managed using a Milwaukee brace, which restricts movement and is associated with reduced physical activity.

The treated girls had worn the brace for an average of 22.9±0.31 hours per day and for a mean total of 45.47±20 months (range 24-104). Girls in the control group were followed up for a mean of 27.77±3.30 years (range 23-35). From the end of treatment to follow-up, there was an average 9.1±7.64 angle in spine curvature change (range 0-27) in those who had worn the brace.

Patients who had scoliosis reported higher overall pain and higher neck- and lower back pain-related disability compared with controls (P <.001), as assessed with the Revised Oswestry Lower Back Pain Disability Index, Rolland-Morris Questionnaire, Quebec Back Pain Disability Scale, Neck Disability Index, and Copenhagen Neck Functional Disability Scale. In addition, participants with scoliosis who wore the brace during adolescence reported higher limitations in lifting, walking, traveling, sitting, rising/standing, social life, and changes in pain intensity compared with healthy controls (P <.001).

The study is limited by its low number of participants, all of whom were women.

Although curve progression appears to be associated with greater pain at long-term follow-up, the investigators suggest that, “patients with painful scoliosis which progresses during the bracing should be fully evaluated for an underlying non-idiopathic cause.”

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Misterska E, Głowacki J, Okręt A, Laurentowska M, Głowacki M. Back and neck pain and function in females with adolescent idiopathic scoliosis: a follow-up at least 23 years after conservative treatment with a Milwaukee brace. PLoS One. 2017;12(12):e0189358.