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Scoliosis Bracing
Wilmington Brace
A surgeon's overview of the Wilmington brace — a custom-moulded underarm scoliosis brace, and what the evidence shows.
The Wilmington brace is one of the established underarm braces for scoliosis, distinguished by being custom-moulded to a cast of the individual trunk. As a spinal surgeon I prescribe braces and monitor the spine; the moulding, fabrication and fitting are the work of a specialist orthotist. This page explains what the Wilmington brace is, how it works and what the evidence tells us.
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 Wilmington brace is
The Wilmington brace is a custom-made thoracolumbosacral orthosis — an underarm brace fabricated as a total-contact body jacket from a cast or mould taken of the patient's trunk, usually while the curve is gently corrected. It opens at the front and is fastened with adjustable straps. Because it is moulded directly to the individual, it fits closely, and like other underarm braces it has no neck or chin component and can be worn under clothing.
How it works
As a total-contact TLSO, the Wilmington brace holds the trunk in a partially corrected position and resists progression of the curve. It is typically prescribed for full-time or near full-time wear, though some studies have found shorter regimens acceptable for smaller curves. As with rigid bracing generally, the results depend strongly on how consistently it is worn.
Who it is for
The Wilmington brace is used for growing children and adolescents with idiopathic scoliosis in the moderate range where bracing is indicated and the curve apex is low enough for an underarm design. As always, whether it is the right choice depends on the individual curve and circumstances, determined at specialist assessment.
What the evidence shows
Long-term studies of the Wilmington brace show that it can control curve progression in a majority of appropriately selected patients, with outcomes broadly comparable to other underarm braces. In one series followed for five to thirteen years, most patients avoided significant progression, and improvement in spinal balance was common. Importantly, these studies also underline a theme common to all bracing: patients who wore the brace faithfully did markedly better than those who did not, with compliance clearly separating success from progression. Comparative reviews have concluded that no single design — Wilmington, Boston, Milwaukee or others — has been shown to be clearly superior to the rest, so the choice is guided by the curve and by what a young person is most likely to wear.
What to expect
The brace is moulded and fitted by a specialist orthotist and adjusted over time as the child grows. It is worn under clothing, removed for washing and usually for sport, and reviewed in clinic with periodic X-rays. 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
- —Bassett GS, Bunnell WP. Influence of the Wilmington brace on spinal decompensation in AIS. (PMID 3652570)
- —Curve progression after treatment with the Wilmington brace for idiopathic scoliosis. (PMID 2298893)
- —Scoliosis in-brace curve correction and patient preference of CAD/CAM versus plaster moulded TLSOs. (PMID 19308530)
- —Brace management in adolescent idiopathic scoliosis (review). (PMC2816747)
- —Negrini S, et al. 2016 SOSORT guidelines. (PMID 29435499 / PMC5795289)
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