A comparison between the Boston brace and the Charleston bending brace in adolescent idiopathic scoliosis

Study Design. The authors studied 319 patients with adolescent idiopathic scoliosis treated at the same institution with either a Boston brace or a Charleston bending brace. Objectives. To determine if both orthoses are equally effective in stopping curve progression and preventing the need for surgical correction. Summary of Background Data. Early reports suggest that the Charleston brace may be comparable to the Boston brace in its effectiveness and that both braces positively influence the natural history of idiopathic scoliosis. Methods. Skeletally immature (Risser 0, 1, or 2) patients with idiopathic scoliosis who were 10 years old or older at the time of brace prescription, had curves from 25°to 45°, and had no prior treatment were studied retrospectively. All measurements were collected by a single observer, and all patients were followed up to skeletal maturity. Results. The Boston brace is more effective than the Charleston brace, both in preventing curve progression and in avoiding the need for surgery. These findings were most notable for patients with curves of 36°-45°, in whom 83% of the those treated with a Charleston brace had curve progression of more than 5°, compared with 43% of those treated with the Boston brace (p < 0.0001). Conclusion. When given the choice between these two orthoses in the treatment of adolescent idiopathic scoliosis, the authors recommend use of the Boston brace. The Charleston brace should be considered only in the treatment of smaller single thoracolumbar or single lumbar curves.