Why is a CTLSO: Milwaukee not recommended for a person with a paralytic spine?

A CTLSO (Cervical-Thoraco-Lumbo-Sacral Orthosis), specifically the Milwaukee type, is designed to provide support and immobilization for the spine in cases such as scoliosis or other spinal deformities. It requires the patient to generate some active forces through muscle engagement to assist in spinal correction and to benefit from the orthotic device.

When dealing with a person who has a paralytic spine, there is a significant absence of voluntary muscle control in areas where the orthosis is intended to work. This lack of active muscular forces means that the corrective capabilities of the Milwaukee orthosis cannot be effectively used, rendering the device ineffective. Therefore, it becomes clear that without the patient's ability to produce the necessary active forces, the orthosis cannot fulfill its intended purpose of spinal alignment and correction.

The implications of this situation include not only the potential ineffectiveness of treatment but also the risk of discomfort, malalignment, or decreased mobility due to the device being improperly suited to the patient's specific needs.