Orthopedic Bracing

If you are diagnosed with a spinal disorder, deformity, or potential problem that can be helped through the use of external structural support, your care provider may recommend the use of a back or neck brace.  Bracing 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.  In fact, more than 99% of orthopedic physicians advocate using them including our orthopedists at Spine & Orthopedic Center.  There are more than 30 types of back supports available for spine disorders.  We will discuss the most common types of back and neck braces.

Back braces

Motion of the lumbar (lower) spine can delay healing in fractures or in post-operative fusions.  Limiting the motion of the spine enhances the healing process for bone in both conditions, and will also usually decrease the patient’s low back pain and discomfort.  Two types of back braces are commonly used to limit the motion in the spine: rigid braces and corset braces (elastic braces).

1. Rigid braces – Rigid braces, such as Boston Overlap braces or Thoracolumbar Sacral Orthosis (TLSO), are form-fitting plastic braces. Provided that the rigid brace is well fitted, it is able to limit approximately 50% of the motion in the spine. Fractures (or broken bones) can often be treated with a rigid brace and may also be used after a fusion surgery. Rigid braces are heavy and hot and tend to be relatively uncomfortable for patients. They should be worn when the patient is up, but may be removed when lying down.

2. Corset braces (elastic braces) – A corset brace is sometimes recommended to limit motion of the spine after a lumbar fusion. The brace helps limit motion in the back while the fusion sets up by not allowing the patient to bend forward. Bone grows better where there is little motion, and especially in cases where no instrumentation (devices to aid in stability) is used, a back brace can be helpful in obtaining a solid fusion.

People with jobs that involve heavy lifting also sometimes wear corset braces. These braces essentially work by limiting motion and acting as a reminder to use proper body posture when lifting. With the corset brace, one needs to lift with the back straight (not bent forward), using the large leg muscles to do the lifting.  Next, let’s review some other types of back bracing

 – Postoperative cervical braces – Because of its relatively small size, the cervical spine is well suited for postoperative bracing. The extent of the surgery typically determines the length of time a collar is recommended after surgery.

Many surgeons will ask patients to wear a collar for:

  • 6 weeks after a one-level fusion
  • Up to 12 weeks after a multi-level fusion

Unfortunately, there is no definitive evidence in the medical literature that points to exactly how long a cervical collar is necessary, or if it is necessary at all.

With fixation techniques (such as anterior plates) it is probably reasonable to use collars mainly for pain control in the initial postoperative period (since most of the actual stability of the spine is from the bone graft and plate).

– Trochanteric Belts – The trochanteric belt is usually prescribed for sacroiliac joint pain or 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/crests. It is about five to eight centimeters wide and it buckles in front, just like a regular belt.

– 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. The 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 compressor force on the joints between the hipbone and sacrum (base of the spine).

 

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.
  • Philadelphia Collar – This is a more rigid/stiff 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 conditions such as: a relatively stable cervical (upper spine) fracture, cervical fusion surgery, or a cervical strain. Another similar type is the Miami cervical brace.
  • Sterno-Occipital Mandibular Immobilization Device (SOMI) – A SOMI is 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.If you look at what the name means, you will better understand what a SOMI does: “sterno” means your upper and middle chest, “occipital” is the base of your skull, “mandibular” refers to your jaw and chin, and “immobilization” describes the support and movement restriction the brace offers. The SOMI is worn on the parts of the body for which it is named. First, there is a chin piece that the lower jaw rests on. Second, the chin piece connects by straps to a headband that is worn across the forehead. Third, the chin piece connects to a chest piece by a front metal extension. Finally, the chest piece then rests on the upper and middle chest – sort of like a vest. This connects to the occipital piece, which supports the base of the head.  This brace is obviously a bit more complicated and cumbersome than some of the others, but it provides excellent support for an injured neck.
  • 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.