Measurement of Milwaukee Brace Pad Pressure in Adolescent Round Back Deformity Treatment

Abstract

Study DesignIn this prospective study, we measured the pad pressures of the Milwaukee brace in adolescent hyperkyphosis treatment.PurposeWe evaluated the skin-brace interface forces exerted by the main pads of the Milwaukee brace.Overview of LiteratureA fundamental factor associated with brace effectiveness in spinal deformity is pad force adjustment. However, few studies have evaluated the in-brace force magnitude and its effect on curve correction.MethodsInterface forces at four pads of the Milwaukee brace were measured in 73 patients withround back deformity (mean age, 14.04±1.97 years [range, 10–18]; mean initial Cobb angle,67.70°±9.23° [range, 50°–86°]). We used a modified aneroid sphygmomanometer to measure the shoulder and kyphosis pad pressures. Each patient underwent measurement in the standing and sitting positions during inhalation/exhalation.ResultsThe mean pad pressures were significantly higher in the standing than in thesitting position, and significantly higher pressures were observed during inhalation compared toexhalation (p=0.001).There were no statistically significant differences between right and left shoulder pad pressures (p>0.05); however, the pressure differences between the right and left kyphosis pads were statistically significant (p<0.05). In a comparison of corrective forces with bracing for less or more than 6 months, corrective force was larger with bracing for less than 6 months (p=0.02). In the standing position, there were no statistically significant correlations between pad pressures and kyphosis curve correction.ConclusionsIn the sitting position, there was a trend toward lower forces at the skin-brace interface; therefore, brace adjustment in the standing position may be useful and more effective. There was no significant correlation between the magnitude of the pad pressures and the degree of in-brace curve correction.

Analysis of the interface pressure exerted by the Chêneau brace in patients with double-curve adolescent idiopathic scoliosis

“…However, these values exceeded the standing position value at maximum tension. Our results are comparable with the study done by Babaee et al, 37 who investigated the action of the Milwaukee brace. This happened when the knee and hip are flexed in the sitting position, pelvic is shifted backward, and thoracolumbar lordosis reduced, and thus interface pressure values also reduced.…”

Adding corrective exercises along with bracing for postural hyperkyphosis among adolescents: A randomized controlled trial

“…In this study, the Milwaukee brace was applied for both experimental groups monitored during treatment. The Milwaukee brace could extend the trunk because of two pairs of thoracic corrective pads, which apply force anteriorly to the curve apex, and shoulder pads, which use pressure posteriorly through the shoulders 5 . The result of the present study showed the positive effect of bracing on improving thoracic hyperkyphosis, which is in line with results of previous studies 27 .…”

“…Corrective exercise (CE) and bracing are considered the two most conventional treatments for thoracic hyperkyphosis 3,5,6 . Bracing is the most effective nonoperative treatment for patients with flexible kyphotic deformity, which has been confirmed in some studies 7 .…”

“…Following the three‐point pressure principle, the brace treats thoracic hyperkyphosis by providing adequate corrective force at the curve apex and reducing lumbar lordosis 5 . For patients with a progressive curve at a thoracic apex of T8 or above, the Milwaukee brace is the best choice for applying a three‐point corrective force at the midthoracic level 5,8 …”

“…According to some practitioners, the relative role of exercise during brace wearing increases progressively because of the efficiency of trunk extensor muscles 3 . Further, the use of bracing and exercise simultaneously is related to considerable impacts on different aspects of adolescents' functions that they may fail the bracing 5 . Therefore, CEs, especially for adolescents, should be recommended for restoring the relevant muscle imbalance and increasing bracing compliance, 3 although limited evidence supports this assumption.…”