IDS ::: Orthotics ::: Spinal Braces

Spinal Braces

Orthoses are frequently used in the treatment of unstable spinal fractures. This is a highly specialised area which is not included in this general overview. Most commonly "off the shelf" spinal orthoses are prescribed for degenerative conditions which cause low back pain. More specialised orthoses are prescribed for the treatment of scoliosis and kyphosis.

Scoliosis can be considered in three categories:

Neuromuscular – where asymmetrical tone causes the spinal column to deform. The spinal orthoses may possibly reduce the rate of curve deterioration. They certainly can be very beneficial with regard to improving posture in conditions such as polio and spina bifida.
Orthopaedic – some rare conditions may cause scoliosis and may benefit from the use of an orthosis. However, serious anomalies such as hemi-vertebrae in the case of a child will almost certainly result in very serious curve deterioration and are beyond the scope of orthoses.
Idiopathic – the efficacy of orthotic management is a matter of some debate. The orthoses are generally designed to reduce the curve angle and degree of rotation by applying three point force systems. They are often worn for up to 23 hours per day for several years. A variety of Thoraco Lumbar Sacral Orthoses are used including the Boston, Cheaneu and Charlston designs. It is considered that in general, curves in excess of 40* Cobb angle or with an apex higher than T8 are beyond the scope of a TLSO. A Milwaukee brace may be used in these situations. However, there are few hard and fast rules in this area of orthotics.

Idiopathic scoliosis bracing is intended to avoid or delay the need for surgery.

Casting for a spinal brace.

Two different results. One spine almost straight in brace the other (below) almost unchanged - why?

Rectifying a spinal cast

Postural Brace for neuromuscular scoliosis.

Idiopathic Scoliosis Spinal Brace at fitting stage. [This brace was designed and fitted by a colleague in Barcelona.]

Extreme hyperkyphosis, too extreme for effective bracing.

A Milwaukee brace. When used for scoliosis these are intended to be worn for 23 hours per day (like most rigid idiopathic scoliosis braces).

Milwaukee braces can also be used for some hyper-kyphosis such as Scheurmann’s disease

The primary principle behind fracture bracing is to support the human endoskeletal system with a synthetic exoskeletal system i.e. – a shell like a crab. When bracing a long bone it generally becomes more difficult the closer the fracture is to a joint.

N.B. This guide does not cover unstable spinal fractures.
Stable low thoracic and thoraco-lumbar fractures are routinely braced with rigid TLSO's.

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