Braces are used to achieve a few objectives depending on the brace type. These objectives include limiting of motion, and unloading discs and vertebral bodies – by so doing, they could be used to control back pain. They are also used to prevent the progression of various spinal deformities, by providing 3-point stabilization. Additionally, braces are used to immobilize the spine, and hence stabilize injured structures including muscles, ligaments and bones. They impact control on spinal flexion, extension, rotation and/or lateral bending.
Braces are named by the body segment they are used to immobilize. These braces include: Lumbosacral Orthosis (LSO) , Thoracolumbosacral Orthosis (TLSO), Cervicothoracolumbosacral Orthosis (CTLSO); Cervicothoracic Orthosis (CTO) and Cervical Orthosis (CO). At times when the lumbosacral spine needs to be immobilized, a leg-extension is added to a TLSO or an LSO brace.
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 neck or back brace. Neck and back braces are most often used to treat low back pain, trauma, infections, muscular weakness, neck conditions and osteoporosis. Depending on the model that is used, they can put the spine in a neutral, upright, hyper-extended, flexed or lateral-flexed position.
Spinal braces are used for a variety of reasons – to control pain, lessen the chance of further injury, allow healing to take place, compensate for muscle weakness and prevent or correct a deformity. They offer a safe, non-invasive way to prevent future problems or to help you heal from a current condition. 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 a person is healed and ready to be taken off the back brace, he or she feels dependent upon it for physical support.
The use of braces is widely accepted. They are effective tools in the treatment of spine disorders. In fact, more than 99% of Orthopaedic physicians advocate using them.
Braces are not new – they have actually been around for centuries. Lumbosacral (lum-bo-sack-ral) corsets (for the lower back) were used as far back as 2000 B.C.! Bandage and splint braces were used in 500 A.D. to treat scoliosis. Recently, braces have become a popular way to help prevent primary and secondary lower back pain from ever occurring.
Braces are flexible, semi-rigid or rigid.
Flexible Orthoses, also called corsets, are used to alleviate pain emanating from postural deformities, trauma or degenerative spine disorders. Corsets are used to offload spinal structures by increasing abdominal compression. Corsets are typically prefabricated and then fitted/modified to each patient’s need. Flexible Orthoses could have rigid inserts included that restrict motion and act as postural reminders.
Rigid Orthoses are used to provide the most stable support to a spinal segment; limiting motion in all planes. It is typically custom-molded. They could be 2-piece (front-back design); or 1-piece design with Velcro straps.
There are more than 30 types of back supports available for spine disorders. Some of the most common types are described below:
Neck braces stabilize the cervical spine after neck surgery, trauma to the neck or as an alternative to surgery. They are the type of spinal brace you most commonly see people wearing. There are several types available, including:
- Soft Collar – a flexible brace 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 & Philadelphia Collar – a more rigid/stiff collar with front and back pieces that attach 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 conditions such as a relatively stable cervical fracture, cervical fusion surgery or a cervical strain.
- Sterno-Occipital (stern-oh-ox-ip-ital) Mandibular (man-dib-you-lar) Immobilization Device (SOMI) – a brace that holds your neck in a straight line that matches up with your spine. It offers rigid support to a damaged neck and prevents the head from moving around. With this brace, you are unable to bend or twist your neck. The restriction of motion helps the muscles and bones to heal from injury or surgery.
- Halo – a brace used 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 metal ring (halo) that goes around your head and secures to your skull with
four metal pins. The ring then attaches by four bars to a vest that is worn on your chest to bear the weight of the brace. The Halo is worn 24 hours a day until the spine injury heals.
- Trochanteric (trow-can-ter-ick) Belt – usually prescribed for sacroiliac joint pain or to stabilize pelvic fractures. The belt fits around the pelvis, between the trochanter (a bony portion below the neck of your thigh bone) and the iliac (pelvis) ridges or crests. The belt is about five to eight centimeters wide and buckles in front, just like a regular belt.
- Lumbosacral (lum-bo-sack-ral) and Sacroiliac (sack-ro-ili-ack) Belt – helps to stabilize the lower back. It is usually made of heavy cotton reinforced by lightweight stays. The pressure can be adjusted through laces on the side or back of the belt. Lumbosacral belts range in widths from 10 to 15 centimeters, and 20 to 30 centimeters. The sacroiliac belt is used to prevent motion by compressing the joints between the hipbone and sacrum at the base of the spine.
- Hyperextension Brace – designed to prevent excessive bending. Hyperextension braces are often prescribed to treat frontal compression fractures that have occurred where the thoracic and lumbar areas of the spine meet. They can also be used after surgery for spinal fusion, taking pressure off the anterior or front of the thoracic vertebrae by restricting flexion (bending) of the thoracic and lumbar spine. Hyperextension braces have a front rectangular metal frame that puts pressure over the upper sternum or breast bone and the pubic bone, allowing the spine to extend. The brace also applies pressure over the T-10 level (the tenth vertebra in your thoracic spine). The hyperextension brace provides what is called “three-point stabilization” to the spine through a front abdominal pad, a chest pad and a rear pad at the level of the fracture. The most common types of hyperextension braces are Cruciform Anterior Spinal Hyperextension (CASH), Knight Taylor and Jewett.