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Bracing

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If you are diagnosed with a spinal disorder, deformity, or potential problem that can be helped through the use of external structural support, your physician may recommend the use of a back or neck brace. Braces offer a safe, non-invasive way to prevent future problems or to help you heal from a current condition.

The use of braces is widely accepted. They are effective tools in the treatment of spine disorders. Braces have actually been around for centuries. Corsets for the lower back were used as far back as 2000 B.C.! Bandage and splint braces were used in 500 A.D. in an effort to correct scoliosis.

There are more than 30 types of back supports available for spine disorders. We will discuss several common types and why they are used.



SCOLIOSIS TLSO BRACE

The decision to brace is important in the treatment of adolescent scoliosis. The goal of bracing is to prevent the existing curvature from progressing while the patient is growing. Bracing is usually done for a scoliosis curvature measured from 25◦ to 40◦ or curves that show progression over time. Population based studies have shown a high likelihood of adult progression when these curvatures are left alone in adolescence to curves often needing surgical correction. Bracing is done to halt this progression in hopes of avoiding eventual surgery. Curves that are 30° to 35° may progress into adulthood and can cause increasing back pain, accelerated disc degeneration, and deformity. Surgery for adolescent idiopathic scoliosis is usually necessary for curves larger than 40° to 45 degrees. Bracing is not recommended for larger curves as it will not change the need for surgical correction.

For patients who need a brace, a light weight thoracolumbosacral (TLSO) brace is most commonly used. This light weight brace is custom molded to the patient's body and is worn under clothes. The brace is most effective when worn constantly and should be worn as much as possible. We recommend 22-23 hours a day. The child may still participate in most sports and activities and on average come out of the brace for hygiene and an hour for activity.

In 2013, a New England Journal of Medicine study was published on the Effects of Bracing in Adolescents with Idiopathic Scoliosis. This study was a multi center study in the US and Canada that looked at outcome differences in patients instructed to wear a rigid brace for at least 18 hours a day versus an observation group. Treatment failure was measured as curve progression to 50 degrees or more. Treatment success was defined as skeletal maturity without this degree of curve progression. The target population was patients with high-risk adolescent idiopathic scoliosis who met brace indications. The majority of patients were placed in a TLSO brace. This trial was actually stopped early because initial results showed a convincing and significant level of effectiveness of bracing. Treatment success was 72% after bracing and only 48% after observation. There was also a positive association between the hours a brace was worn and the rate of treatment success. This study clearly demonstrates the effectiveness of using a TLSO brace and also confirms that the longer you wear the brace, the more success we will have in preventing curve progression.

Spinal Specialist, Dr. Christopher Good, Outlines Idiopathic Scoliosis & Treatment Options.

 


Neck Braces

Neck braces are used to provide stability of the cervical spine after neck surgery, a trauma to the neck, or as an alternative to surgery. They are probably the type of spinal brace you most commonly see people wearing. There are several types available, including:

Soft Collar
This flexible brace is placed around the neck. It is typically used after a more rigid collar has been worn for the major healing. It is used as a transition to wearing no collar.

Miami J Cervical Collar 
This is a rigid collar that has a front and back piece that attaches with Velcro on the sides. It is usually worn 24 hours a day until your physician instructs you to remove it. This collar is used for a relatively stable cervical fracture, cervical fusion surgery, or a cervical strain.

Halo
The main purpose of the halo is to immobilize the head and neck. This is the most rigid of the cervical braces. It is only used after complex cervical spine surgery or if there is an unstable cervical fracture. The halo looks a lot like the word sounds. It has a titanium ring (halo) that goes around your head, secured to the skull by four metal pins. The ring then attaches by four bars to a vest that is worn on the chest. The vest offers the weight to hold the ring and neck steadily in place. The Halo is worn 24 hours a day until the spine injury heals.

Back Braces

Sacroiliac and Lumbosacral Belts

The lumbosacral belt helps to stabilize the lower back. These belts are usually made of heavy cotton reinforced by lightweight stays. Pressure can be adjusted through laces on the side or back of the belt. These belts range in widths between 10 to 15 centimeters, and 20 to 30 centimeters. The sacroiliac belt is used to prevent motion by putting a compressive force on the joints between the hipbone and sacrum.

Corsets

Corsets provide rigidity and support for the back. Corsets can vary in length. A short corset is typically used for low back pain, while a longer one is used for problems in the mid to lower thoracic spine. When people think of corsets, they usually conjure up images of women from earlier centuries who used them to make their waists look smaller. Today, in the treatment of back problems, corsets refer to a type of back brace that extends over the buttocks and is often held up by shoulder straps. Like the corsets of old, these lace up from the back, side, or front. There are metal stays that provide the appropriate rigidity and support for the back.

Rigid Braces

These braces are typically prescribed for low back pain and instability. If greater rigidity is needed to support the spine, rigid frame spinal bracing is often prescribed. These are stiff braces usually consisting of rear uprights that contour to the lumbar spine and pelvis, along with thoracic bands. There are also fabric straps on the braces that provide pressure in the front. Common types of rigid models are:

Hyperextension Braces

This brace is designed to prevent excessive bending, and it is often prescribed to treat frontal compression fractures that have occurred around the junction of the thoracic and lumbar spine or pars fractures. The brace can also be used for post surgery healing from a spinal fusion. These braces offer support that restricts flexion of the spine. The most common types of Hyperextension Braces are Knight Taylor and Jewett.

Lifting Belts

These belts are designed to reduce low back strain and muscle fatigue that can occur when you are lifting heavy objects. The belt circles around the waist, covering the lumbar region of the spine, and closes in front. These belts are usually made of cloth or canvas and do not have stays. Some models also have lordosis pads.

 


Clinical Uses

The braces/supports are most frequently used to treat: low back pain, trauma, infections, muscular weakness, neck conditions, and osteoporosis. Braces, belts, and jackets are designed to immobilize and support the spine when there is a condition that needs to be treated. Depending on the model that is used, they can put the spine in a neutral, upright, hyper-extended, flexed, or lateral-flexed position.

Goals of Spinal Bracing

Spinal bracing is used for a variety of reasons: control pain, lessen the chance of further injury, allow healing to take place, compensate for muscle weakness, or prevent or correct a deformity. More specifically, lumbar corsets and braces compress the abdomen, which increases the intra-abdominal pressure. This act allows pressure on the vertebral column to unload, providing some relief.

There are other reasons bracing is used. One is the theory that they insulate the skin, producing increased warmth that decreases the sensation of pain - much like a heating pad. Another reason is that the increase in abdominal pressure produces hydraulic support for the back. Finally, certain types of movement may cause stress to the pain generators in the back. The decrease in range of movement by using bracing may relieve this type of pain.

Though the effects of bracing are primarily positive, they can lead to a loss of muscle function, due to inactivity. Bracing can sometimes lead to psychological addiction, so that even when the patient is healed and ready to be taken off the back brace, he or she feels dependent upon it for physical support.

 

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