Spinal Bracing

Why must I wear a brace?

When you visit our practice for treatment, your physician may recommend that you wear a brace for your neck or back. Some patients find braces uncomfortable or inconvenient, but they serve a very important purpose. Braces are used to immobilize and support the spine. Sometimes they are also used to correct spinal deformity. This article will provide a thorough overview of the purpose and proper use of braces, so that you will understand their value for your healing.

What are braces?

Braces are external devices that support the muscular and bony structures of the spine. In the past, many spine patients were required to wear heavy plaster casts. Fortunately, patients that must wear braces today benefit from lighter weight plastic braces that have been designed with the patient’s comfort in mind.

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 the soft lumbar corset, the rigid lumbar or TLSO brace, and the cervical collar.

The cervical collar

A cervical collar may be used after a cervical injury or cervical surgery. Cervical collars come in soft or hard varieties. The soft collar is used in a manner similar to the lumbar corset. It is also used for about six weeks after a cervical surgery. The rigid collar is used for more severe instabilities or injuries, and may be used for a longer period of time.

The soft lumbar corset

The soft lumbar corset is used primarily for muscular support in the lowback. A lumbar corset may be used for individuals who have extensive arthritis or mild instability of the lumbar spine. Many times, the additional muscular support offers relief of a patient's low back pain. The corset may also act as a reminder to avoid excessive low back motion and may help to encourage proper body mechanics such as good posture.

Our patients are often concerned that excessive use of such a corset might weaken the lumbar muscles. If you use the brace constantly, this will likely occur. For this reason, the specialists at our practice do not recommend continuous, daily use of a lumbar corset. Rather, we suggest its use in a "task specific" manner. The brace should be employed when you are involved in activities that place your back at risk. When this "at risk" activity is finished, the brace should be removed.

Use of such a brace should also be done in conjunction with a lumbar strengthening exercise program. Ideally, the lumbar strengthening exercise program will increase muscle strength, which makes the brace unnecessary. Unfortunately, such a program takes many months to have this effect. The brace can help support the spine until muscle strength can do the job.

The lumbar corset is also used after most lumbar spinal surgeries to provide additional low back support, thus preventing the muscles from rapidly fatiguing during the recovery process. The brace will also offer that gentle reminder that activities and motion must be limited for healing to occur. The purpose of the brace is not for complete immobilization. As such, feel free to use the lumbar corset when it helps, and take the brace off when it no longer helps. Most patients will find the brace to be quite helpful for the first six weeks after surgery with diminishing use of the brace thereafter. We recommend that initially the brace be used whenever you are out of bed for more than 15 minutes. You can begin to wean yourself from the brace whenever you are ready.

The rigid lumbar or TLSO brace

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. This type of fracture has its 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, this brace must be worn for approximately three months whenever the patient is out of bed.

After undergoing very complex spinal surgeries, and despite the use of internal fixation, the spine may not be satisfactorily stabilized. The reason for this may have to do with the severity of the instability, the lack of bone quality, the location of the surgery, or the nature of the deformity. In this situation, a rigid brace may be needed. Here 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 three months after surgery. Your surgeon will let you know if such a brace is necessary.

Rigid braces are also used for the correction of scoliosis in the growing adolescent. 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. Under such circumstances, surgery to correct the scoliosis may eventually be necessary despite many years of bracing. Ideally however, the brace may replace the need for surgery.

The brace for scoliosis is a rigid plastic brace and must be worn 18 out of 24 hours per day. Ongoing brace adjustments are necessary to maximize the scoliosis correction. If you are required to wear a brace to treat adolescent scoliosis, it will be necessary to visit the clinic every three months.

In rare circumstances, very restrictive braces that utilize thigh cuff extensions to control the pelvis are needed. 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 questionable. These patients are at a unique risk. Should such a situation arise, it will be candidly discussed with you.

Conclusion

Braces can be an essential component to the successful treatment of your spinal disorder. Although braces may require you to restrict some activities or form different habits, the support braces provide will speed your healing and may prevent further injury. Please discuss any concerns you have about braces with your physician.

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Butterfly Foundation


With the Butterfly Foundation, Dr. Moulton and his colleagues teach spine surgery in communities that need it around the world. See a short video, then learn more about the foundation here.