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.
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.