Back brace

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Front view of a pre-moulded plastic back brace with nylon torso and shoulder straps made for a female adolescent or pre-adolescent patient Teenage girls back brace - front.jpg
Front view of a pre-moulded plastic back brace with nylon torso and shoulder straps made for a female adolescent or pre-adolescent patient

A back brace is a device designed to limit the motion of the spine in cases of bone fracture or in post-operative spinal fusiona, as well as a preventative measure against some progressive conditions or to correct patient posture.

Contents

Common back braces include:

Bracing for scoliosis

Back braces are prescribed to treat adolescent idiopathic scoliosis, as they may stop the progression of spinal curvature in a growing child/adolescent. As of 2016, the Scientific Society on Scoliosis Orthopaedic and Rehabilitation Treatment (SOSORT) recommends bracing "is important, but does not have to be applied to all patients with this specific need" [2] for idiopathic scoliosis during growth. Multiple studies have provided strong evidence of bracing as an effective conservative treatment for children and adolescents and may also help decrease the amount of curvature in the spine; [3] with results lasting several decades following the end of treatment and brace weaning. [4] A variety of brace styles are available; the Boston brace is the most commonly used brace for adolescent idiopathic scoliosis (AIS). It is important to note that in-brace correction has been found to be directly related with treatment success, [5] suggesting in-brace correction should be maximized; thus individualized custom braces which maximize in-brace correction show better results. Other designs include the Milwaukee brace, the Charleston bending brace, the Peak Scoliosis Bracing System, and the SpineCor (a soft brace) in the United States, Canada, and Europe. In Europe, however, the SPoRT and Cheneau and Crass Cheneau braces are also used. There has been considerable research and information published in reputable journals on back braces for scoliosis. Issues like patient compliance with treatment, the psycho-social impact of brace use, and exercise with bracing have been looked at. Quality of Life research has been attempted but is difficult due to a current lack of instruments. Bracing is the primary treatment for AIS in curves that are considered to be moderate in their severity and are likely due to progress (determined by curve pattern/type and the patient's structural maturity).

Full rigid TLSO back brace - fitted to female adolescent patient showing issues with the patient fitting around hips and pelvic areas Full shell back brace - fitted to female adolescent.jpg
Full rigid TLSO back brace – fitted to female adolescent patient showing issues with the patient fitting around hips and pelvic areas

Boston brace

A Boston brace is a form of thoracolumbosacral orthosis (TLSO). It is the most commonly used brace in the United States. It is a symmetrical brace. It corrects curvature by pushing with small pads placed against the ribs, which are also used for rotational correction (here it tends to be slightly less successful, however). These pads are usually placed in the back corners of the brace so that the body is thrust forward against the brace's front, which acts to hold the body upright. The brace opens to the back, and usually runs from just above a chair's seat (when a person is seated) to around shoulder-blade height. Because of this, it is not particularly useful in correcting very high curves. It also does not correct hip misalignment, as it uses the hips as a base point. This brace is typically worn 20–23 hours a day.[ citation needed ]

Charleston bending brace

This brace was designed with the idea that compliance would increase if the brace were worn only at night. The brace is asymmetrical and fights against the body's curve by over-correcting. It grips the hips much like the Boston brace, and rises to approximately the same height, but pushes the patient's body to the side. It is used in single, thoracolumbar curves in patients 12–14 years of age (before structural maturity) who have flexible curves in the range of 25–35 Cobb degrees.[ citation needed ]

Chêneau-Gensingen Brace (CGB)

This brace is designed for use with the Schroth physical therapy method. It utilizes large, sweeping pads to push the body against its curve and into blown out spaces. The Schroth theory holds that the deformity can be corrected through retraining muscles and nerves to learn what a straight spine feels like, and breathing deeply into areas crushed by the curvature to help gain flexibility and to expand. The brace helps patients to keep doing their exercises throughout the day. This brace is asymmetrical, and is used for patients of all degrees of severity and maturity. It is often worn 20–23 hours a day. The brace principally contracts to allow for lateral and longitudinal rotation and movement.[ citation needed ]

Flexpine brace

Flexpine brace is a hybrid type of brace for use by non-surgical scoliosis patients. It is of 0.04 inches thickness and uses foldable urethane/plastic as its frame so that the wearer can still move his/her body. It is a customized product made of 3D printing material. It has an elastic band to push the curved part of the spine. This is so patients can bend their spine easier. Patients can do spine realigning exercise while wearing Flexpine brace, so they can reduce their overall treatment time by exercising and conveying the brace treatment simultaneously.[ citation needed ]

Milwaukee brace

Female adolescent (14 years old) patient wearing a Milwaukee brace, with neck ring and mandible pad showing Milwaukee brace - with neck ring and mandible pad.jpg
Female adolescent (14 years old) patient wearing a Milwaukee brace, with neck ring and mandible pad showing

The Milwaukee brace was a very common brace towards the earlier part of the twentieth century in the United States. It is a largely symmetrical brace. The brace is made with a harness-like hip area and metal strips rising to the chin, where a collar (neck ring) is held in place. Between the hips and chin, there are corrective thrusts given with large pads.[ citation needed ]

There is little rotational correction. Today this brace is generally used for very high thoracic curves that are severe and out of range of the Boston. This brace is typically worn 20–23 hours a day.[ citation needed ]

Silicon Valley Brace

This brace is similar to that of the Rigo-Cheneau or other Cheneau type braces in that it incorporates an individualized correction designed based on the individual's scoliosis curve pattern as determined by x-ray or MRI imaging. The brace is designed in three dimensions utilizing CAD software similar to other modern braces and is manufactured out of thermoplastic allowing for further modifications based on the individual's growth over time. Based on current scientific literature, this asymmetric brace type is designed to both prevent progression as well as reduce the curve as in-brace correction correlates to treatment outcome. [5] This brace type is typically worn upwards of 18+ hours a day in conjunction with other conservative treatment options including physiotherapy scoliosis-specific exercises [6] such as Schroth.

SpineCor brace

The brace has a pelvic unit from which strong elastic bands wrap around the body, pulling against curves, rotations, and imbalances. It is most successful when the patient has relatively small and simple curvatures, is structurally young, and compliant—it is usually worn 20 hours a day. The patient is not to have it off for more than two hours at a time. While it is expected that patients can participate in activities as strenuous as competitive gymnastics while in brace, it also pulls down against shoulder misalignments which compress the spine. SpineCor is marketed as a more comfortable, less restricted scoliosis brace option for adults. This brace was invented in Montréal, and is used across the country as well as being widely used in other countries. [7]

Sport brace

SPoRT stands for "Symmetric, Patient-oriented, Rigid, Three-Dimensional active," which it intends[ clarification needed ] to be. The brace is symmetrical, built with a plastic frame reinforced with aluminum rods. The brace corrects hip misalignments through padding. Large, sweeping, thick pads push the spine to a corrected position. To prevent overcorrection, however, the brace also has "stop" pads holding the spine from moving too far in the other direction. The brace runs from just above the chair to T3 in many instances—it is successful at correcting high thoracic curves. In front, it goes around the patient's breast and up, even to pushing against the collar bone. Though it sounds restricting, it has been tested for comfort while participating in athletics. The theory holds that the support that the brace gives will[ clarification needed ] help the patient's body learn to work as though it had no curve muscularly. Then the muscles would be able to support the spine, preventing further collapse. This brace is used for all curve patterns and types, even ones considered past brace treatment by other schools. The brace is typically worn 22 hours a day, and often coupled with a physical therapy program.[ citation needed ]

Bracing for other purposes

Thoracolumbosacral orthosis

A thoracolumbosacral orthosis (TLSO), is a two-piece plastic brace supporting the spine from the thoracic vertebrae of the chest, to the base of the spine at the sacrum.[ citation needed ]

The rigid lumbar or TLSO (Thoraco – Lumbo – Sacral – Orthosis) is used, when regardless of surgical correction, or in some cases in place of surgical correction, spinal stability has not been fully achieved. In some cases of spinal fractures these can be managed without surgery using such a TLSO brace but this is only in the case where the type of fracture has its own inherent stability. The brace provides additional immobilization, which should safely allow condition or fracture to heal with a minimal risk of further injury. Under these circumstances, this brace must be worn for approximately several months whenever the patient is out of bed. In other cases the doctor or orthotist may prescribe such a brace to deal post-surgery immobilization, or for the longer-term treatment of conditions of a more progressive nature, such as correction of scoliosis in the growing adolescent. These are described briefly below:[ citation needed ]

After having undergoing complex spinal surgeries, this is especially the fusion procedures, a brace will probably be necessary. There are a number of factors determining the need for brace wear include: – the severity of any instability, the lack of good bone quality, the location of the surgery, or the nature of the deformity. In these situations, a rigid brace may be needed.

TLSO back brace - thoracolumbosacral orthosis, a brace for the mid to lower spine Full TLSO orthopedic back brace.jpg
TLSO back brace – thoracolumbosacral orthosis, a brace for the mid to lower spine

Once again, the brace is specifically for immobilization and support. It should be worn whenever the patient is out of bed for more than 10 minutes. This brace will be worn for approximately several months after surgery but your doctor or surgeon will let the patient know if such a brace is necessary.

Adolescent female patient shown in a rigid plastic moulded TLSO orthopedic brace Full rigid shell back brace - fitted to female adolescent 23 hours daily.jpg
Adolescent female patient shown in a rigid plastic moulded TLSO orthopedic brace

Rigid braces are also used for the correction of scoliosis in the growing children and adolescents. These braces are very specific in nature and are used until the adolescent has finished growing (usually to about 16 years of age). Use of a brace does not always control the scoliosis curvature. Indeed, the curvature in very aggressive scoliosis can continue to progress despite bracing. Typically in such circumstances, surgery to correct the scoliosis could eventually be necessary despite many years of bracing. However, the brace may replace the need for surgery and this is always preferred if possible.[ citation needed ]

The brace for scoliosis is a rigid plastic brace and must be worn a minimum of 18 out of 24 hours per day. Ongoing brace adjustments will needed and are necessary to maximize the scoliosis correction. If you are required to wear a brace to treat ongoing adolescent scoliosis, it will be necessary to visit the clinic or doctor or orthotist every few months. In a few circumstances, very restrictive braces that utilize thigh cuff extensions to control the pelvis are sometimes needed and this type of brace is worn to treat a very specific situation, such as a patient who has undergone pelvic fusion where the bone quality is at risk or questionable.[ citation needed ]

The brace comes in a variety of forms and can be used for treating severe or unstable compression fractures as well as other injuries and conditions. [8]

Jewett brace

TLSO Jewett hyperextension body brace fitted to adolescent female patient in full support body suit Hyperextension body brace fitted to adolescent female patient in body suit 3.jpg
TLSO Jewett hyperextension body brace fitted to adolescent female patient in full support body suit

A Jewett (hypertension) brace is a hyperextension brace that prevents the patient from bending forward too much. This brace designed to give support to the patient's thoracic and lumbar spine by preventing twisting and flexion (bending forward). [8]

Corset brace

A corset brace is similar to a traditional corset. It typically has metal or plastic stays to limit forward movement. It puts pressure over the belly to take pressure off of the spine and promote healing.[ citation needed ]

Posture brace / posture corrector

A posture brace or a posture corrector is to help people improve their postures and maintain their bodies in a straight and upright position.[ citation needed ]

Posture corrector realign body to its original position by straightening from ankle to knee, pelvis, and shoulders to ear.[ citation needed ]

See also

Related Research Articles

<span class="mw-page-title-main">Scoliosis</span> Medical condition of the spine

Scoliosis is a condition in which a person's spine has an abnormal curve. The curve is usually S- or C-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not typically cause problems, but more severe cases can affect breathing and movement. Pain is usually present in adults, and can worsen with age. As the condition progresses, it may impact a person's life and hence, can also be considered a disability.

<span class="mw-page-title-main">Kyphosis</span> Medical condition

Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave lordotic curving of the cervical and lumbar regions of the spine is called lordosis. It can result from degenerative disc disease; developmental abnormalities, most commonly Scheuermann's disease; Copenhagen disease, osteoporosis with compression fractures of the vertebra; multiple myeloma; or trauma. A normal thoracic spine extends from the 1st thoracic to the 12th thoracic vertebra and should have a slight kyphotic angle, ranging from 20° to 45°. When the "roundness" of the upper spine increases past 45° it is called kyphosis or "hyperkyphosis". Scheuermann's kyphosis is the most classic form of hyperkyphosis and is the result of wedged vertebrae that develop during adolescence. The cause is not currently known and the condition appears to be multifactorial and is seen more frequently in males than females.

<span class="mw-page-title-main">Pectus carinatum</span> Medical condition

Pectus carinatum, also called pigeon chest, is a malformation of the chest characterized by a protrusion of the sternum and ribs. It is distinct from the related malformation pectus excavatum.

<span class="mw-page-title-main">Harrington rod</span>

The Harrington rod is a stainless steel surgical device. Historically, this rod was implanted along the spinal column to treat, among other conditions, a lateral or coronal-plane curvature of the spine, or scoliosis. Up to one million people had Harrington rods implanted for scoliosis between the early 1960s and the late 1990s.

<span class="mw-page-title-main">Kyphoscoliosis</span> Medical condition

Kyphoscoliosis describes an abnormal curvature of the spine in both the coronal and sagittal planes. It is a combination of kyphosis and scoliosis. This musculoskeletal disorder often leads to other issues in patients, such as under-ventilation of lungs, pulmonary hypertension, difficulty in performing day-to-day activities, psychological issues emanating from anxiety about acceptance among peers, especially in young patients. It can also be seen in syringomyelia, Friedreich's ataxia, spina bifida, kyphoscoliotic Ehlers–Danlos syndrome (kEDS), and Duchenne muscular dystrophy due to asymmetric weakening of the paraspinal muscles.

<span class="mw-page-title-main">Scheuermann's disease</span> Medical condition

Scheuermann's disease is a self-limiting skeletal disorder of childhood. Scheuermann's disease describes a condition where the vertebrae grow unevenly with respect to the sagittal plane; that is, the posterior angle is often greater than the anterior. This uneven growth results in the signature "wedging" shape of the vertebrae, causing kyphosis. It is named after Danish surgeon Holger Scheuermann.

<span class="mw-page-title-main">Milwaukee brace</span>

The Milwaukee brace, also known as a cervico-thoraco-lumbo-sacral orthosis or CTLSO, is a back brace most often used in the treatment of spinal curvatures in children but also, more rarely, in adults to prevent collapse of the spine and associated pain and deformity. It is a full-torso brace that extends from the pelvis to the base of the skull. It was originally designed by Blount and Schmidt in 1946 for postoperative care when surgery required long periods of immobilization.

The Boston brace, a type of thoraco-lumbo-sacral-orthosis (TLSO), is a back brace used primarily for the treatment of idiopathic scoliosis in children. It was developed in 1972 by M.E "Bill" Miller and John Hall at the Boston Children's Hospital in Boston, Massachusetts.

Minimally invasive thoracic spinal fusion is one of the newest approaches to scoliosis surgery. Instead of a vertical scar down the back or horizontal from the middle of the chest to the center of the back, a rod is inserted through a series of small incisions on the side of the body. The spine is not exposed during the surgery; a small scope is used instead.

Axial Biotech, Inc. was a privately held molecular diagnostics company based in Salt Lake City, Utah. It was founded in 2002.

<span class="mw-page-title-main">Scoliosis Research Society</span> International professional organization

The Scoliosis Research Society (SRS) is a non-profit, professional, international organization made up of physicians and allied health personnel, whose purpose is to "care for those with spinal deformity throughout life by patient care, education, research and patient advocacy." It was founded in 1966 with 37 members, and now has grown to include over 1300 spinal deformity surgeons and allied health personnel in 41 countries, with a primary focus on providing continuing medical education for health care professionals, and funding/support for research in spinal deformities. Among the founding members were Dr. Paul Randall Harrington, inventor of the Harrington rod treatment for scoliosis, and Dr. David B. Levine, spine surgeon at Hospital for Special Surgery. Harrington later served as President of the SRS from 1972 to 1973, and Levine was President of the Society from 1978 to 1979. Current membership primarily includes spinal deformity surgeons, as well as some researchers, physician assistants, and orthotists who are involved in research and treatment of spinal deformities. Strict membership criteria ensure that the individual SRS Fellows are dedicated to the highest standards of care for adult and pediatric spinal deformities, utilizing both non-operative and operative techniques.

<span class="mw-page-title-main">Orthotics</span> Medical specialty that focuses on the building and designing of artificial legs

Orthotics is a medical specialty that focuses on the design and application of orthoses, sometimes known as braces or calipers. An orthosis is "an externally applied device used to influence the structural and functional characteristics of the neuromuscular and skeletal systems." Orthotists are professionals who specialize in designing these braces.

<span class="mw-page-title-main">Neuromechanics of idiopathic scoliosis</span>

The neuromechanics of idiopathic scoliosis is about the changes in the bones, muscles and joints in cases of spinal deformity consisting of a lateral curvature scoliosis and a rotation of the vertebrae within the curve, that is not explained by either congenital vertebral abnormalities, or neuromuscular disorders such as muscular dystrophy. The idiopathic scoliosis accounts for 80–90% of scoliosis cases. Its pathogenesis is unknown. However, changes in the vestibular system, a lateral shift of the hand representation and abnormal variability of erector spinae motor map location in the motor cortex may be involved in this disease. A short spinal cord and associated nerve tensions has been proposed as a cause and model for idiopathic scoliosis. Besides idiopathic scoliosis being more frequent in certain families, it is suspected to be transmitted via autosomal dominant inheritance. Estrogens could also play a crucial part in the progression of idiopathic scoliosis through their roles in bone formation, growth, maturation and turnover. Finally, collagen, intervertebral disc and muscle abnormalities have been suggested as the cause in idiopathic scoliosis, although these are perhaps results rather than causes.

Lateral electrical surface stimulation is a neuromuscular stimulation treatment for idiopathic scoliosis. It is also known as the LESS treatment, and was invented by Dr. Jens Axelgaard in 1976. It is a non-invasive scoliosis treatment that utilizes electrical muscle stimulation, which is also known as neurostimulation or neuromuscular stimulation.

The management of scoliosis is complex and is determined primarily by the type of scoliosis encountered: syndromic, congenital, neuromuscular, or idiopathic. Treatment options for idiopathic scoliosis are determined in part by the severity of the curvature and skeletal maturity, which together help predict the likelihood of progression. Non-surgical treatment should be pro-active with intervention performed early as "Best results were obtained in 10-25 degrees scoliosis which is a good indication to start therapy before more structural changes within the spine establish." Treatment options have historically been categorized under the following types:

  1. Observation
  2. Bracing
  3. Specialized physical therapy
  4. Surgery

Katharina Schroth was a German physiotherapist, best known for developing the Schroth Method to treat scoliosis.

Anterior vertebral body tethering (AVBT) is a relatively new surgery for the treatment of scoliosis in pediatric patients. Left untreated, severe scoliosis can worsen and eventually affect a person's lungs and heart.

The Providence brace is a nighttime spinal orthosis for the treatment of adolescent idiopathic scoliosis (AIS). The brace is used to curb the natural progression of the disease and prevent further curvature of the AIS patient's spine. The Providence brace was developed by Charles d'Amato and Barry McCoy, and is manufactured by Spinal Technology, Inc.

<span class="mw-page-title-main">Adolescent idiopathic scoliosis</span> Medical condition

Adolescent idiopathic scoliosis is a rather common disorder in which the spine starts abnormally curving sideways (scoliosis) at the age of 10–18 years old. This disorder generally occurs during the growth spurt that happens right before and during adolescence. In some teens, the curvature is progressive, meaning that it gets worse over time, however this is rare, since it is more common for this variant of scoliosis to show itself as a mild curvature.

<span class="mw-page-title-main">Halo-gravity traction device</span> Device used to treat spinal deformities

Halo-gravity traction (HGT) is a type of traction device utilized to treat spinal deformities such as scoliosis, congenital spine deformities, cervical instability, basilar invagination, and kyphosis. It is used prior to surgical treatment to reduce the difficulty of the following surgery and the need for a more dangerous surgery. The device works by applying weight to the spine in order to stretch and straighten it. Patients are capable of remaining somewhat active using a wheelchair or a walker whilst undergoing treatment. Most of the research suggests that HGT is a safe treatment, and it can even improve patients' nutrition or respiratory functioning. However, some patients may experience side effects such as headaches or neurological complications. The halo device itself was invented in the 1960s by doctors working at the Riancho Los Amigos hospital. Their work was published in a paper entitled "The Halo: A Spinal Skeletal Traction Fixation Device." The clinician Pierre Stagnara utilized the device to develop Halo-Gravity traction.

References

  1. The Effects of Three Different Types of Orthoses on the Range of Motion of the Lumbar Spine During 15 Activities of Daily Living., Spine 36(26):2346-53, February 2011
  2. Negrini S, Donzelli S, Aulisa AG, Czaprowski D, Schreiber S, de Mauroy JC, Diers H, Grivas TB, Knott P, Kotwicki T, Lebel A, Marti C, Maruyama T, O'Brien J, Price N, Parent E, Rigo M, Romano M, Stikeleather L, Wynne J, Zaina F (2018-01-10). "2016 SOSORT guidelines: orthopaedic and rehabilitation treatment of idiopathic scoliosis during growth". Scoliosis and Spinal Disorders. 13: 3. doi: 10.1186/s13013-017-0145-8 . PMC   5795289 . PMID   29435499.
  3. Weinstein SL, Dolan LA, Wright JG, Dobbs MB (October 2013). "Effects of bracing in adolescents with idiopathic scoliosis". The New England Journal of Medicine. 369 (16): 1512–21. doi:10.1056/NEJMoa1307337. PMC   3913566 . PMID   24047455.
  4. Aulisa AG, Guzzanti V, Falciglia F, Galli M, Pizzetti P, Aulisa L (2017). "Curve progression after long-term brace treatment in adolescent idiopathic scoliosis: comparative results between over and under 30 Cobb degrees – SOSORT 2017 award winner". Scoliosis and Spinal Disorders. 12: 36. doi: 10.1186/s13013-017-0142-y . PMC   5662099 . PMID   29094108.
  5. 1 2 Clin J, Aubin CÉ, Sangole A, Labelle H, Parent S (August 2010). "Correlation between immediate in-brace correction and biomechanical effectiveness of brace treatment in adolescent idiopathic scoliosis". Spine. 35 (18): 1706–13. doi:10.1097/BRS.0b013e3181cb46f6. PMID   21330954. S2CID   5468450.
  6. Berdishevsky H, Lebel VA, Bettany-Saltikov J, Rigo M, Lebel A, Hennes A, Romano M, Białek M, M'hango A, Betts T, de Mauroy JC, Durmala J (2016). "Physiotherapy scoliosis-specific exercises – a comprehensive review of seven major schools". Scoliosis and Spinal Disorders. 11: 20. doi: 10.1186/s13013-016-0076-9 . PMC   4973373 . PMID   27525315.
  7. Dunn S (January 23, 2008). "Amazing brace". Maclean's. Archived from the original on 2010-05-23.
  8. 1 2 "Jewett vs. TLSO Replies". OANDP-L on oandp.com. 2010-09-27. Retrieved 2012-09-02.

Further reading