Back brace

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

Common back braces include:

• Rigid (Hard) braces : These braces are form-fitting plastic molds that restrict motion by as much as 50%; and
• Soft braces : Elastic braces that limit forward motion of the spine and assist in setting spinal fusions or supporting the spine during occasions of stress (for example, employment requiring the lifting of heavy loads).

Bracing for scoliosis

Back braces are also commonly prescribed to treat adolescent idiopathic scoliosis, as they may stop the progression of spinal curvature in a growing child/adolescent. In some cases, the back brace may also help decrease the amount of curvature in the spine. A variety of brace styles are available; the Boston brace is the most commonly used brace for adolescent idiopathic scoliosis (AIS). 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, 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).

One large issue in bracing for scoliosis is patient compliance, as mentioned above. Compliance is often impacted by the other above-mentioned factors (psycho-social comfort, exercise), but there are others also, including ability to eat and move, pain, and physical deformation. Back braces, especially the Boston brace, puts a great deal of pressure on the abdomen and can make digestion uncomfortable. Scoliosis braces, like those used for correcting post-operatively and for fractures, inhibit motion to a large extent, though percentages are difficult to find. Patients frequently complain about the inability to tie their own shoes, sit on the floor, etc. Bracing is also painful, though the body can adapt to tolerate the pain. Braces can also deform the patient's existing bone structures, most notably the hips, though there have been complaints about rib cage deformities as well.

Boston brace

Main article: 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.

Milwaukee brace

Main article: Milwaukee brace

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 is. Between the hips and chin, there are corrective thrusts given with large pads. 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.

Charleston bending brace

This brace was designed with the idea that compliance would increase if the brace were worn only at night. It is asymmetrical. The brace fights against the body's curve by over-correcting. It grips the hips much like the Boston, 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.

SpineCor brace

This is currently the only widely used soft 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 compresses the spine. Long-term results are also, largely, in the making. SpineCor is also the only scoliosis brace for adults. This brace was invented in Montréal, Canada and is used across the country as well as being widely used in other countries.

SPoRT brace

SPoRT stands for "Symmetric, Patient-oriented, Rigid, Three-Dimensional active," which it intends 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 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.

Cheneau brace

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 longditutal rotation and movement.

Crass Cheneau brace

The Crass Cheneau® dynamic scoliosis brace, is made of a special hypoallergenic polypropylene (approved for direct contact with the human body), with thickness 2 mm to 2.5 mm, translucent when applied in our body. The mode of its construction, with negative pressure, its minimum thickness, and the almost zero weight of it, gives perfect fit to user's body, making it tolerable, invisible, functional, and above all, directly correctional on the deformations of the spine. Its effectiveness lies in the circumferential arrays pressures to the preform and in the tapered load at the structure of one (1) only typical vertebra, per case, by applying them during the molding of the brace. The array circumferential pressures of a deformed spine (e.g. from idiop. Scoliosis) minimize the resistance of the spine in the deformed area (dynamic type of curve), and the axial compression forces (Delmas indicator), decommission the shift mechanism - sideways bending - on the thoracic spine (which in idiopathic scoliosis is followed by the deformation of the spine in Cobb angle) and the mechanical resistance, limiting the range of motion of the thoracic column and the lateral bending.It is often worn 12–16 hours a day.

Bracing for other purposes

TLSO

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. 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:

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. 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.

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.

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.

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.

Jewett brace

A Jewett brace is a hyperextension brace that prevents the patient from bending forward too much. It is often used to facilitate healing of an anterior wedge compression fracture involving the T10 to L3 vertebrae.

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.

See also

• Orthotics

References

• Atanasio S, Zaina F, Negrini S. The SPoRT (Symmetric, Patient-oriented, Rigid, Three-Dimensional active) concept for scoliosis bracing: principles and results. ISICO (Italian Scientific Spine Institute). PMID 18401104
• Blount WP. Use of the Milwaukee brace. Orthop Clin North Am. 1972 Mar;3(1):3-16.
• Emans JB, Kaelin A, Bancel P, Hall JE, Miller ME. The Boston bracing system for idiopathic scoliosis. Follow-up results in 295 patients.Spine. 1986 Oct;11(8):792-801.
• Howard A, Wright JG, Hedden D. A comparative study of TLSO, Charleston, and Milwaukee braces for idiopathic scoliosis. Spine. 1998 Nov 15;23(22):2404-11.
• Wong MS, Cheng JC, Lam TP, et al. The effect of rigid versus flexible spinal orthosis on the clinical efficacy and acceptance of the patients with adolescent idiopathic scoliosis. Spine 2008;33:1360-5.
• Coillard C, Circo A, Rivard CH. A new concept for the non-invasive treatment of Adolescent Idiopathic Scoliosis: the Corrective Movement principle integrated in the SpineCor System. Disabil Rehabil Assist Technol. 2008 May;3(3):112-9.
• Katz DE, Durrani AA. Factors that influence outcome in bracing large curves in patients with adolescent idiopathic scoliosis. Spine. 2001 Nov 1;26(21):2354-61
• Korovessis P, Zacharatos S, Koureas G, Megas P. Comparative multifactorial analysis of the effects of idio. pathic adolescent scoliosis and Scheuermann kyphosison the self-perceived health status of adolescents treated with brace. Patras, Greece. PMID 16953447
• Sherman KA. Pilot study to validate a scoliosis-specific instrument that measures quality of life and treatment effect. Scoliosis. 2007. 2(Suppl 1): P11.
• Vasiliadis E, Grivas TB, GkoltsiouK. Development and preliminary validation of Brace Questionnaire (BrQ): a new instrument for measuring quality of life of brace treated scoliosis. Attica, Greece. PMID 16759366
• Vasiliadis E, Grivas TB, Savvidou O, Triantafyllopoulos G. The influence of brace on quality of lifeof adolescent with scoliosis. Attica, Greece. PMID 17108451
• Krassas M, Ergeletzis D, Mavros Ch. Non-invasive treatment of Adolescent Idiopathic Scoliosis: asymmetric dynamic brace Crass Cheneau®. Scoliosis 2016. EDU 17839926