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Scoliosis Bracing
Milwaukee Brace
A surgeon's overview of the Milwaukee brace — the original modern scoliosis brace, its role today, and what the evidence shows.
The Milwaukee brace holds a special place in the history of scoliosis treatment: it was the brace that began the modern era of non-surgical management. As a spinal surgeon I prescribe braces and monitor the spine, while the fabrication and fitting are the work of a specialist orthotist. This page explains what the Milwaukee brace is, why it matters historically, where it still fits, and what the evidence shows.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What the Milwaukee brace is
The Milwaukee brace is a cervicothoracolumbosacral orthosis, or CTLSO — a full-length brace that runs from a pelvic base up to a neck ring, with metal uprights connecting the two. It was introduced by Walter Blount in the 1940s, originally for post-surgical support, and it ushered in the modern practice of bracing scoliosis. Because it extends up to the neck, it can address curves whose apex is high in the thoracic spine, which underarm braces cannot reach as effectively.
How it works
The brace applies corrective forces through pads mounted on the uprights and through the pelvic base, encouraging the trunk to lengthen and straighten. Its tall design gives it reach over high thoracic curves. Historically it was worn full-time over long periods, often combined with an exercise programme.
Who it is for
In modern practice the Milwaukee brace is used much less often than it once was, having been largely replaced for most curves by lower-profile underarm braces such as the Boston brace, which young people tolerate far better. Its main remaining role is for high thoracic curves that an underarm brace cannot control, where the reach of a CTLSO is genuinely needed. Whether it is appropriate is a specialist decision based on the curve pattern and its apex.
What the evidence shows
The Milwaukee brace has a long evidence record. Classic series showed it to be effective at controlling and partially correcting mild to moderate curves, with better results in younger patients, more flexible curves and — a recurring theme — cooperative patients and families. Longer-term studies found success, defined as keeping curves below the surgical threshold, more often with the brace than with observation. It is not without downsides: the visible neck ring made it hard to wear for self-conscious teenagers, and its more conspicuous design has been associated with a greater psychological and body-image burden than underarm braces, alongside recognised issues such as skin irritation and, with the original neck design, jaw problems. These drawbacks are the main reason it has been superseded for most curves, while remaining useful for the high curves it was uniquely designed to reach.
What to expect
Where a Milwaukee brace is used, it is fitted and adjusted by a specialist orthotist and reviewed in clinic with periodic X-rays. Because it is more demanding to wear, support from the whole team is especially important. As with any growth-phase brace it is continued until skeletal maturity and then gradually withdrawn, with the spine monitored throughout.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and investigations, treatment options, potential risks, expected recovery and outcomes depend upon an individual's diagnosis, symptoms, medical history, examination findings, skeletal maturity, curve pattern and personal circumstances. A brace should be prescribed and monitored by a specialist team and designed and fitted by a qualified orthotist. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —The Milwaukee brace in idiopathic scoliosis: evaluation of 123 completed cases. (PMID 954276)
- —Milwaukee brace treatment of idiopathic scoliosis: late results. (PMID 598139)
- —A history of bracing for idiopathic scoliosis in North America. (PMC2816759)
- —Long-term effects of Milwaukee brace treatment on body image and mental health in idiopathic scoliosis. (PMC5825107)
- —Back and neck pain and function at least 23 years after Milwaukee brace treatment. (PMC5724838)
- —Negrini S, et al. 2016 SOSORT guidelines. (PMID 29435499 / PMC5795289)
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