Boston brace

Boston Brace

The Boston Brace, also known as the Boston Orthosis or the Thoraco-Lumbo-Sacral-Orthosis (TLSO), is a type of spinal orthosis designed to manage the curvature of the spine due to conditions such as scoliosis. Developed in the early 1970s at the Boston Children's Hospital, the Boston Brace has become one of the most widely used bracing methods for the treatment of scoliosis in adolescents.

Design and Function

The Boston Brace is custom-made from a plaster cast of the patient's torso to ensure a snug fit. It is primarily constructed from polypropylene and designed to apply three-point pressure to the curvature of the spine, aiming to halt progression and potentially correct the spinal curvature. The brace covers the body from the armpits to the start of the pelvic area in the front and extends from the scapulae to the tailbone in the back.

The brace operates on the principle of providing outward pressure at the apex of the curve while supporting the back and front of the body. This design helps to realign the spine into a more natural position. Ventilation holes are often added to the brace to improve comfort for the wearer.

Indications

The Boston Brace is primarily indicated for individuals with idiopathic scoliosis presenting a spinal curvature between 20 and 40 degrees. It is most effective in patients who are still growing, as the brace can guide the growth of the spine. The decision to use a Boston Brace is typically made after a thorough evaluation by a specialist in spinal disorders, who will consider factors such as the type, location, and severity of the curve, as well as the patient's age and growth potential.

Usage

Patients are generally instructed to wear the Boston Brace for 18 to 23 hours per day, removing it only for bathing and certain physical activities. The duration of use varies depending on the patient's condition and how much growth they have remaining. Regular follow-up appointments are necessary to adjust the brace as the patient grows and to monitor the progression of the spinal curvature.

Effectiveness

Studies have shown that the Boston Brace, when used as directed and in the appropriate patient population, can be effective in preventing the progression of scoliotic curves in a significant number of cases. Success rates vary, but compliance with wearing the brace for the recommended duration each day is a critical factor in achieving positive outcomes.

Challenges and Considerations

Wearing a Boston Brace can be challenging, especially for adolescents, due to physical discomfort, self-consciousness, and the need for lifestyle adjustments. Support from healthcare providers, family, and peer support groups can be invaluable in helping patients adapt to wearing the brace.

Conclusion

The Boston Brace remains a cornerstone in the non-surgical management of adolescent idiopathic scoliosis. Its design, tailored to each patient, offers a non-invasive option to address spinal curvature and has a track record of effectiveness in preventing curve progression during growth. Ongoing research and development in materials and design continue to improve the comfort and efficacy of the Boston Brace and similar orthotic devices.