Spinal Bracing

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Braces are sometimes recommended to people suffering with spinal problems. Braces are a simple, conservative method that can help immobilize and support the spine. Braces can also be effective in helping to correct a spinal deformity. While braces may feel uncomfortable at first and may seem inconvenient, they are a very important type of treatment.

What are braces?

Braces are external devices that support the spine’s muscular and bony structures. In the past, patients who needed this kind of spinal support could only get it by wearing heavy plaster casts. Modern braces today are designed in lightweight plastic materials.

Braces are categorized as rigid or soft. Rigid braces are used to restrict movement, while soft, elastic type braces provide muscular support while allowing movement.  

Commonly used braces include:
 

• Cervical collar
• Soft lumbar corset
• Rigid lumbar
• Thoraco-lumbo-sarcal orthosis or TLSO brace

Cervical Collar

A cervical collar or “neck brace” may be used after a neck injury or cervical surgery. Cervical collars come in soft or hard varieties.  

A soft cervical collar is flexible and wraps around the neck, and can be secured by Velcro® fasteners in the back. It is easy to put on and take off, and may be removed at times. A soft cervical collar is worn for several weeks after injury of surgery, as specified by the physician.

A rigid collar is stiff and the front and back of the collar may be secured by Velcro® fasteners.  This type of collar is used for more severe cases of spinal instability or injury and may be required for a longer period of time than a soft collar.

Soft Lumbar Corset

A soft lumbar corset is primarily used to provide low back muscular support. A lumbar corset may be used for individuals who have extensive arthritis or mild lumbar instability.  The additional muscular support provided by a soft lumbar corset often provides low back pain relief. The soft lumbar corset may encourage proper posture and body movements and serve as a reminder to avoid extreme back motions.

Excessive or constant use of a soft lumbar corset may weaken lumbar muscles. For this reason, it is recommended that a soft lumbar corset be reserved for task-specific use. This type of brace should be used during activities that might put the back at risk. When that activity is completed, the corset may be removed. Further, a lumbar-strengthening exercise program should be started in conjunction with the corset. Ideally, this lumbar-strengthening program will increase muscle strength to the point that the brace is no longer needed. Since it can take months to build up adequate back muscle strength, the use of this brace can help prevent injury or further pain in the interim.

The lumbar corset is also used after most lumbar spinal surgeries to provide additional low back support, thus preventing muscles from rapidly fatiguing during recovery. The corset also offers that gentle reminder that activities and motion must be limited for healing to occur.

For surgical patients, the soft lumbar corset is not intended to prevent mobility. Following surgery, patients are usually instructed to use the soft lumbar corset as needed. Most patients find the support of the corset quite helpful in the first six weeks after surgery, and then they “wean” themselves from the brace little by little. Typically, patients should wear the soft lumbar corset whenever they are out of bed for more than 15 minutes in the first days following surgery.

Rigid Lumbar Braces

A rigid brace is used when, despite surgical correction (or in place of surgical correction), spinal stability has not been fully achieved. For example, some types of spinal fractures can be managed without surgery. Such fractures have their own inherent stability.  The brace provides additional immobilization, which should safely allow the fracture to heal with a minimal risk of further injury. Under these circumstances, a rigid lumbar brace  must be worn for approximately three months whenever the patient is out of bed.

In some cases, following complex spinal surgery, the spine may not be satisfactorily stabilized even when internal fixation mechanisms are used. There are many reasons this could occur, including the severity of the back injury, the complexity of the surgery, bone quality, location of the surgery, nature of the deformity, or others.In such cases, a rigid lumbar brace may be needed. The rigid lumbar brace is specifically for immobilization and support. Patients are usually instructed to wear the rigid lumbar brace whenever they are out of bed for more than 10 minutes. Typically, a rigid lumbar brace is worn for about three months following surgery. How long the brace is required will vary by the patient.

Thoraco-Lumbo-Sacral-Orthosis, or TLSO

Scoliosis in adolescents may be corrected using a special type of rigid brace known as the TLSO brace. A TLSO brace is a plastic brace specifically designed to treat scoliotic curves. A TLSO brace is worn 18 hours or more every day. This kind of brace must be adjusted frequently as the child grows and as the scoliosis curve changes. TLSO patients should expect to come to the clinic for check-ups at least every three months.

A TLSO brace is used until the adolescent stops growing, usually around age 16. The goal of a TLSO brace is to control the scoliosis curvature and help avoid scoliosis surgery. It should be noted that in some cases of very aggressive scoliosis, the brace may not be able to prevent the progression of scoliosis. In such cases, surgery may be necessary to correct the scoliosis even after years of bracing.

Other Braces

In rare circumstances, very restrictive braces with thigh cuff extensions to control the pelvis are needed. This type of brace might be required for a pelvic fusion patient with poor bone quality. Braces exist or can be created to address even unusual or unique cases.

Conclusion

Braces may be an essential component in the successful treatment of various spinal disorders. Braces may help patients avoid surgery, enhance healing, prevent injury, and provide comfort and support. Many patients report that braces help their posture and remind them to be careful in how they move. Modern materials make braces more comfortable than ever. While braces may be restrictive, they are an important part of some back treatment programs.