These braces must be worn at all times and are most effective for those with curves at T8 (bottom of the shoulder blades) or lower. As a brace that is worn at all times, including when standing, the full-time brace must hold the head above the pelvis and remain comfortable enough to wear throughout the day and at night.
The Boston brace is the most common brace utilized for treating scoliosis. It is a thoracic-lumbar-sacral orthosis (TLSO), although some models also contain a neck extension for cases of high curvature.
The Boston brace is custom fit from measurements or a cast. Trim lines and corrective pads are then added to the brace, to influence the curve development.
This brace type works by applying pressure to outward or convex side of the curve in the spine while having cutouts on the opposite side of the brace so that the spine naturally shifts in that direction.
This brace is similar to the Boston brace, but it is a completely custom brace formed from a cast of a the body taken while laying down. Also, this brace does not utilize cutouts, making it a full-contact TLSO.
The Milwaukee brace is a cervico-thoraco-lumbo-sacral (CTLSO) brace. It is more involved than the Boston or Wilmington Brace and rarely used now. The design of this brace extends from the neck to the pelvis, and it includes a neck ring and pelvic girdle, which help to keep the head centered over the pelvis. Otherwise, it works similarly to the Boston brace by using strategically-placed pads to squeeze the spine into a corrective position.
Compared to full-time braces, nighttime braces are only intended to be worn while lying down, which means they can apply stronger forces to the spine and are not restricted by the head’s need to remain over the pelvis.
During the day, the head must remain above the pelvis, but this is not necessary for braces only worn at night. As such, nighttime braces often treat scoliosis by overcorrecting the spinal curve, and while this would be uncomfortable for someone to endure during the day, it is relatively easy for a patient to hold this position while sleeping.
Charleston Bending Brace
The Charleston Bending Brace is the most common nighttime brace utilized, and it is created based on a cast or scan of the patient’s torso, making it a custom option. Using an x-ray of the patient’s spine, corrective forces are then added to the brace to help it reach proper alignment.
The providence brace works similarly to the Charleston brace by overcorrecting the spine. However, instead of bending the spine in the opposite direction, which is what the Charleston brace does, the Providence brace instead elevates one shoulder slightly and applies lateral and rotational forces to the curve(s).