Science can often be dry and cold, and many discoveries and inventions have come along only because of the human intervention factor. Childhood scoliosis braces have been around for ages and ages, however, some of the more advanced and more comfortable braces have come into fruition truly because of some sensitive individuals and their patients, one of which was the daughter of the inventor himself. Let’s take a look at the history of scoliosis bracing and we will clue you in on some surprising ways that more advanced and comfortable braces have been developed. There is nothing like actual personal experience even among the most experienced doctors and ortho specialists and we will soon see exactly what that means.

In fact, unfortunately even the most successful, devoted, and experienced medical professionals cannot beat actual experience with illness or other medical issues that have happened to themselves or close members of their family. For example, I know a devoted and beloved doctor who recently suffered from grave complications from a kidney transplant. These types of snags happen to only one in one hundred kidney transplant patients. This doctor who is thankfully improving has gained monumental knowledge in the field of kidney disease that he could have never learned in school.

Some of our heroes in the development of bracing for idiopathic scoliosis are Walter Blount, Bill Miller, John Hall Ralph Hooper, Jr. among other innovators in this field. This article will touch on the developers and the braces that they fabricated while trying to give the human side to bracing history. We also want to stress the importance of orthotists as opposed to doctors in the invention of the most effective scoliosis braces. Even if these professionals do not have an MD after their name, nevertheless they are the ones who actually have the right feeling and experience to make the correct brace for each person.

Dr. Walter Blout, Dr. Albert Schmidt & The Milwaukee Brace

One of the first children’s scoliosis clinics in America to open was at Boston’s Children’s Hospital in 1890. The jacket/brace was made from plaster, rigid metal and included a neck ring. This was later called a version of the Milwaukee Brace. At that time in history, if someone wanted a non-surgical cure for adolescent idiopathic scoliosis this was the most common choice until the 1970’s. The child had to be fitted with a girdle, rigid metal rod and neck ring. This brace is still used today in certain instances for lumbar lordosis. It keeps the pelvis in a back tilting position using a pelvic corset made from leather. The rest of the brace is attached at an angle to a ring around the patient’s neck in which the throat mold is placed right under the chin and keeps the head in a certain position. It is quite a complicated appropriation.

G. Dean MacEwen & The Wilmington Brace

It wasn’t until 1969 that a better option was introduced. It’s so strange that nothing better was invented before 1969 to improve on the cumbersome Milwaukee Brace. Only because of a determined patient, a new brace called the Wilmington Brace was created. MacEwen was the chief of services at the Alfred I. Dupont Institute when he recommended the standard Milwaukee Brace in 1969 to a female patient. Low and behold, she refused this cumbersome contraception as well and only would agree to wear a brace that was undetectable even though, MacEwen tried offering her an alternative cast she was not buying.

At first, MacEwen thought that the girl’s request was quite unreasonable but with no alternative to save the child, he together with some other innovative colleagues created this removable brace. It fits like a jacket but has a front closure. It’s custom-made by using a plaster mold of the patient’s torso.

Bill Miller, John E. Hall and the Boston Brace

When a brave teenager who was a patient of John E. Hall and orthotist Bill Miller refused to wear a Milwaukee type brace; they were forced to design a less restrictive and more comfortable brace especially for this valiant teen. The Boston Brace is still used in a more modern model until today.

Bill Miller who was born in 1927 and died in 1992 founded Boston Brace in 1970. He was grabbed from his own successful orthotist business in Indiana to come to the Children’s Hospital in Boston where he created the Boston Brace. Bill jumped at the chance to develop new techniques in bracing because the Boston hospital was a branch of Harvard Medical School Teaching Hospital of which Hall was anxious to be a part of.

Dr. Hall and orthotist Bill Miller were the perfect combination to conceive the Boston Brace System for the purpose of treating scoliosis. The module that they designed was a thoracolumbar-pelvic innovation that came in different sizes and could be configured according to each person’s curvature and age. This idea might seem rudimentary today but, in those days, it was no less than revolutionary. The pressure areas would be specific to each person’s unique curvature.

Today there are a variety of Boston Braces that cater to each individual scoliosis sufferer.

The Boston Brace Original is still considered the main system for scoliosis with specific types custom-made for thoracic, lumbar or a combination of both problems. The standard brace comes with a back opening which gives optimal results consistently.

The Boston Brace Night Shift has gained popularity since it is worn exclusively while sleeping. This brace applies direct, oppositional forces to straighten the curves.

The Boston Brace Kyphosis Brace is used when there is an outward sway called, kyphosis when viewing the spine sideways or for lordosis which means an inward sway.

The Boston Brace RC is a custom-made asymmetrical brace with a front opening. It incorporates the style closely of the Rigo-Cheneau brace.

The Boston Brace 3D is the most up to date brace of all of Boston Orthotics bracing devices and ensures maximum curve correction. It is manufactured by utilizing a digital laser scanning system which measures the patient precisely. There are several other models used for other problems in babies or for people with low muscle tone which can be researched as well.

The Rigo-Chêneau Brace method is the gold standard throughout the world for the successful handling of idiopathic scoliosis thereby avoiding serious surgery.

C. Ralph Hooper, Jr. & The Charleston Bending Brace

Similarly, to Hall and Miller’s motivation for the invention of the Boston Brace, Ralph Hooper’s took a personal turn in l980 when his ten-year-old daughter, Jessica, was diagnosed with adolescent idiopathic scoliosis. Since her evaluation determined that she suffered from a right thoracic scoliosis she was not a candidate for the Boston Brace, and she would have to be fitted with the dreaded Milwaukee Brace. Jessica said something like, “No I will not wear that monstrosity on my neck.” Her father could not disagree since he had seen firsthand the damage that the Milwaukee Brace was having emotionally and socially to children suffering from scoliosis and having no alternative but that ring around the neck.

Jessica started out with a 30-degree thoracic curve, wore the new brace for two years with her curve reduced to a perfect zero. The Charleston Bending Brace can both conform to the child’s body and bend at the same time. Dr. Hooper admitted that the invention of this innovative brace was the highlight of his career. He made the Charleston Bending Brace especially for his daughter, Jessica and the results were amazing.

The way the Charleston Bending Brace works is that it is molded to fit the specific patient’s body while bending toward the curve while the patient is sleeping. That was the beginning of this innovation but with time patients were able to wear the brace for up to 23 hours a day.

Final Words

We have touched upon several bracing options for children suffering from scoliosis. There are other variations as well which should be presented as options to parents. What I have learned is that there is no such thing as the word no in inventing. So many revelations have been introduced by determined pioneers in all different fields. The common factor is a will to succeed. In the little bit of history, we introduced to you we showed you two ideas. Number one, “if there’s a will, there’s a way”. There is no better encouragement than a child who has a will of their own. It’s very hard to refuse a child when you know deep down in your heart that they are absolutely right. This was especially true in the case of Jessica, Ralph Hooper’s own daughter. How could he possibly refuse the one person he loves the most in the whole world?

The second idea is that it’s often the orthotist, not the doctor who is the expert on scoliosis bracing. Keep this in mind when researching the different options. A doctor can recommend the which brace and the orthotist will explain why that specific one.

There are many white papers that discuss the effectiveness of various therapies for treating adolescent idiopathic scoliosis (AIS) but few are brought down to a comprehensive level for parents. Years of research are done along with the aggregation of highly credible data from prominent medical journals. But what does n = 56 + 63 + 102 + 34 + 80 mean to a mother looking for treatment options for her daughter’s scoliosis? 

The objective of the content below is to extract the main information from a white paper titled “The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis (AIS): A Systematic Review and Meta-Analysis” done by the Journal of Clinical Medicine and make it comprehensive to any parent whose child is suffering from scoliosis. The white paper was published by the Journal of Clinical Medicine on May 15, 2021, making it very relevant to patients with adolescent idiopathic scoliosis.

Basic Definitions To Makes Sense Of Study On Scoliosis Bracing Therapy

Prior to delving into the actual study and findings, it’s important to define certain terms that will be used in the white paper. Most of the words that will be used are related to the spinal skeletal maturity of the pelvic area of the patient. Readers should be cognizant that the spine rests directly on top of the sacrum bone which is supported by the pelvis.

Ossification: This is the abnormal bone formation generally referring to soft tissues becoming calcified and hardened. Often soft tissue can become hardened through the conversion into calcium which is referred to as “calcified”. For laymen such as us it means a soft area by the bone becoming hard.

Iliac Apophysis: When this term is being used it’s referring to an inflammation around the tendon areas situated near the front of the pelvis. The inflammation could be caused by injury but in our case it’s the irregular growth of the child that causes it. For us layman such as us it means inflammation of the tendons in the front pelvic area. 

The Risser Staging System: Dr. Joseph C. Risser (1892 – 1982) was someone who was monumental in treating scoliosis. Risser recognized that the abnormal bone formation and tendon inflammation of the pelvic area (ossification of the iliac apophysis) had very much to do with the patient’s spinal skeletal maturity. In 1958 his many years of research was recognized and clinicians had begun to refer to the gradual maturity of the pelvic bone structure as the Risser sign. The Risser staging system in the United States measures four stages (1 – 4) while the Risser staging system in France measures five stages (1 – 5). These measurements play an important role in how to treat adolescent idiopathic scoliosis and are referred to in different sample sizes in the white paper conducted by the Journal of Clinical Medicine. 

The Tanner Staging System: Dr. James Tanner was a British pediatrician who in 1969 established a staging system for girls as they progressed through puberty. This staging system can be also referred to as Sexual Maturity Rating  or better known as SMR. The Tanner grade is measured in five stages (1 – 5) and shows various stages of development in boys and girls. As per treating scoliosis the Tanner grade can make a difference in how doctors and therapists treat AIS (adolescent idiopathic scoliosis).

Why Was The Study On Bracing in Adolescent Idiopathic Scoliosis Done?

To get a glimpse into what is the objective of the study, we first need to understand the inspiration for the aggregation of such detailed research on scoliosis bracing. Any parent whose child has scoliosis understands the challenging lifestyle that the condition brings with it. Besides the pain increasing with further progression of scoliosis of the spine, there are negative social elements as well. Scoliosis patients tend to find it hard to fit into the proper clothing due to having uneven shoulders and will often cover up to show less flesh during the hot summer months. This can negatively impact their social life which can in turn be detrimental to friendships and establishing more meaningful relationships. 

What if there was a non-invasive solution to treat and correct adolescent idiopathic scoliosis? That’s where scoliosis bracing comes into conversation. Ever since the origination of the creation of the Lyons Brace in 1948, doctors and therapists have been trying to develop a non-invasive approach for treating scoliosis. But the question always remained if bracing therapy is effective enough to alter an adolescent’s lifestyle by having them wear a brace full time. Though brace creators like Dr. Jacques Cheneau of France, and Dr. Emanuel Rigo of Barcelona, Spain have tried to make a light, fitted, and more comfortable brace, still no one said wearing an orthopedic device is easy. In addition, most brace therapies require the brace to be worn around the clock.

This is why the Department of Orthopaedic Surgery in conjunction with the University Medical Center Utrecht, both residing in The Netherlands, grouped a research team to investigate how effective scoliosis brace therapy is. The findings would help justify brace therapy for treating adolescent idiopathic scoliosis. 

What Were The Findings In The Study?

To give the findings credibility, a variety of scoliosis braces were chosen for the study most of which were rigid and were worn full time. There was one brace called the SpineCor Soft Brace, which was soft but was still worn full time. The Charleston and Providence braces were the only night time braces worn in the study group. Researchers wanted to get a bird’s eye view from general bracing therapy for scoliosis and were not biased towards any particular brace. 

When an orthotist wants to determine if the brace therapy regimen was successful they will look at the progression of the spinal curvature. In general, the ideal treatment plan for scoliosis would result in a normal Cobb angle of 10° or lower. In the study, success was defined as ≤5° curve progression during the follow-up visit after brace therapy. Therefore, if a patient started out at a 20° scoliosis curve and treatment brought it down to 15°, the study would call that a success. 

The study population varied between 23 to 843 patients in which multiple bracing devices were used in each study. Every patient kept to the specific brace given to them throughout the treatment period. The Boston brace, which was used in three studies in a total of 169 patients, saw an average of a 67% success rate (53% – 83%). In another four studies, the Rigo-Chêneau brace was used and saw a success rate of 80% and was most effective in lumbar curves. The Progressive Action Short Brace (PASB) was used in two separate studies of 69 and 163 patients and saw a success rate between 65.6% and 100%. Similarly, the Lyon brace was used in 69 patients and reported a success rate of 99%. 

Conclusion

The commonality between all of the brace therapy treatments for patients was that it was indeed an effective method of treatment for scoliosis. The rigid braces were more effective then the soft brace, and as you guessed it, full time wearing was more effective than part time wearing. Other important findings included brace therapy for scoliosis in Risser stages 0 – 2 and 0 – 3 of bone maturity appeared to be most effective. As the staging for skeletal maturity increases the effectiveness for scoliosis bracing therapy decreases. This is why it’s important that patients with adolescent idiopathic scoliosis get seen sooner rather than later in order that bracing therapy remains on the table as an option for treatment.

Another interesting finding in one of the studies was that when comparing the TLSO brace (thoraco-lumbo-sacral orthosis) to the Rigo-Chêneau brace, no patients of the Rigo-Chêneau brace required scoliosis surgery as opposed to 34% of TLSO brace patients required scoliosis surgery. This is one of the only findings that  sided with one brace over the others in the comparative analysis. From there it appears that the Rigo-Chêneau brace is a highly effective method of bracing therapy for treating scoliosis and to avoid surgery.  

Final Words

 Whether or not you decide to seek brace therapy for your child is a conversation that should be between you, your pediatrician, and your child. Choosing to treat scoliosis with a brace will mean your child adhering to the prescribed treatment regimen for it to be most effective. After reviewing the study on The Effectiveness of Different Concepts of Bracing in Adolescent Idiopathic Scoliosis, it is clear that a full time treatment regimen is more efficient for treating scoliosis. With bracing therapy comes wearing the brace all throughout the day with short breaks for bathing. Though it’s tough to get used to at first, most adolescents will get used to it within a couple of weeks. Perhaps treatment will be complete within a twelve month period or sooner based on the time it takes to correct the spinal curvature. With all the discomfort that a patients endures during this period, it is they who are the true heroes. No surgery and normal spinal curvature, and that’s a win win for all. If your child has scoliosis, do a little research into bracing therapy and see if it’s right for them. As per this type of scoliosis therapy, a little discomfort can be truly a life changer. Good Luck!