Spinal Orthoses Health Article

Definition

Spinal orthoses, also known as braces, are devices worn on the body to treat conditions such as scoliosis, back pain, and injury.

Purpose

Most spinal orthoses are designed to adjust skeletal alignment, limit torso movement, and compress the stomach.

Scoliosis

Spinal orthoses are used to treat longterm spinal conditions such as scoliosis. The brace is worn to stop the progression of scoliosis, which is the lateral (side-to-side) curvature of the spine. This condition progresses as a person grows and is primarily seen in children and adolescents. In general, scoliosis can not be reversed. Therefore, the goal of treatment is stop the progression of scoliosis.

Orthopedists usually diagnosis this condition based on an x-rays showing curves of 10 degrees or more. Treatment is usually indicated when curves measure 25 degrees or more. Scoliosis progresses more slowly as

patients reach skeletal maturity, so use of spinal orthosis is prescribed for patients with at least 18 months of growing left. In older patients, scoliosis is treated with surgery.

Back pain

Spinal orthoses are worn to relieve back pain and to provide back support after an injury or to treat conditions such as degenerative disc disorder. Other uses of spinal orthoses include protecting the back after surgery and the stabilization and support of a weak back.

Description

For more than two thousands years, doctors have tried to treat scoliosis by having patients wear devices to keep their spines rigid. Equipment used throughout the centuries included bandages bolstered by splints, leather appliances, and plaster casts. During the Middle Ages, the craftsmen who made armor for knights also produced bulky metal corsets to stop the progression of scoliosis.

Today, braces made of materials ranging from cotton to plastic are used to treat conditions related to the back and spine. Spinal orthoses vary in size from the cloth belts worn for back support to the rigid full-torso Milwaukee brace used to stop the progression of scoliosis. Braces used to treat scoliosis are prescribed by an orthopedist. The orthosis may be custom-made or fitted from a prefabricated brace.

Corsets and belts

Cloth corsets and belts are generally made of cotton, nylon, or rayon. These flexible orthoses are used to relieve back pain and to restrict movement.

Rigid and semi-rigid spinal orthoses

The braces worn to treat scoliosis or during rehabilitation from spinal surgery are generally classified as rigid or semi-rigid orthoses. The rigid orthosis immobilizes the spine and prevents spinal motion. It is designed to apply force in every direction, distributing pressure over a broad area. A semi-rigid brace combines the support of a rigid brace with the flexibility of a cloth orthosis.

Orthoses for scoliosis

Orthoses prescribed for the treatment of scoliosis generally fall into three categories, with model variations in each group.

THE MILWAUKEE BRACE. The Milwaukee brace is a full-torso orthosis developed during the late 1940s. Named for the location of the doctors who developed it, the orthosis consists of pressure pads held in place by three vertical metal bars. The bars extend from a neck ring, a type of collar worn around the neck. The bars are secured at the neck ring and anchored to a plastic pelvic girdle. The rear vertical bar extends down the back. There are two shorter bars in front.

The neck ring centers the head and straightens the spine. The pads apply pressure to the spinal curve to keep it from worsening. Patients wear the brace under clothing, and it is worn for much of the day. While it effectively stops the progression of scoliosis, wearing the brace with the visible neck ring can be embarrassing for patients.

LOW-PROFILE BRACES. During the 1970s, doctors in Boston developed a brace that extends from under the arms to the hips. Variations of this brace are known as thoracolumbar-sacral orthoses (TLSOs), the Boston brace, the low-profile brace, and the underarm brace. The orthosis consists of a plastic corset with pressure pads attached to the inside. The original braces opened from the back. Current models open in the front or back. However, the back-opening orthosis generally keeps the pelvis in place. This reduces the flattening of the lower back that can occur when scoliosis is treated with an orthosis.

Patients wear the underarm brace for much of the day. This orthosis is regarded as low-profile because it is not visible when worn under clothes.

THE CHARLESTON NIGHTTIME BENDING BRACE. This orthosis developed in 1979 forces the spine to one side. It is held in place away from the direction of the spinal curve. The bending brace is curved and is designed to be worn only at night when the patient sleeps. Most patients have no trouble sleeping in this brace once they have adjusted to wearing it. In addition, many young patients appreciate the option of wearing th brace only at home and going to school without wearing a brace.