Spinal bracing utilizes these primary objectives:
-Controlling back pain by limiting motion and unloading discs, vertebrae and other spinal structures by compressing the abdomen.
-Stabilizing weak or injured structures by immobilizing the spine.
-Providing three-point force systems to provide correction or prevent progression of a deformity.
The segment of the body that is being controlled generally classifies spinal bracing terminology. Sacroiliac (SIO), lumbosacral (LSO), thoracolumbosacral (TLSO), cervicothoracolumbosacral (CTLSO), cervical (CO) and cervicothoracic (CTO) orthoses. Control is described in terms of spinal flexion, extension, rotation and lateral bending.
Spinal orthoses are categorized as flexible, rigid or semi-rigid.
Flexible orthoses or corsets are prescribed for relief of low back pain associated with degenerative disc disorders, trauma, or postural deformities. Corsets are typically made of cotton and nylon materials. Corsets are used to de-weight spinal structures by increasing abdominal compression. Rigid stays and inserts can be added to restrict motion and act as a postural reminder. Most corsets are pre-fabricated and custom fit and modified to the patient’s specific needs.
Rigid orthoses are commonly custom fabricated and provide the most support to the area being treated. A body jacket or TLSO controls motion in all planes. Depending on the goals of the TLSO, design can be modified accordingly. A two piece front and back design is commonly used post operatively for ease of application while a front or back opening single piece design is commonly utilized when treating scoliosis. Velcro™ straps are most commonly used to fasten the closure on all orthoses today.
There are several types of commonly used scoliosis braces:
1. Thoraco-Lumbo-Sacral-Orthosis (TLSO)
The most common form of a TLSO brace is called the “Boston brace,” and it may be referred to as an “underarm” brace. This brace is fitted to the child’s body and custom molded from plastic. It works by applying three-point pressure to the curvature to prevent its progression.
It can be worn under clothing and is typically not noticeable. The TLSO brace is usually worn 23 hours a day, and it can be taken off to swim, play sports, or participate in gym class during the day.
This type of brace is usually prescribed for curves in the lumbar or thoraco-lumbar part of the spine.
2. Cervico-Thoraco-Lumbo-Sacral-Orthosis (known as a Milwaukee brace)
The Milwaukee brace is similar to the TLSO described above, but also includes a neck ring held in place by vertical bars attached to the body of the brace.
It is usually worn 23 hours a day, and can be taken off to swim, play sports or participate in gym class during the day.
This type of brace is often prescribed for curves in the thoracic spine.
3. Charleston Bending Brace
This type of brace is also called a “nighttime” brace because it is only worn while sleeping. A Charleston back brace is molded to the patient while they are bent to the side, and thus applies more pressure and bends the child against the curve. This pressure improves the corrective action of the brace.
This type of brace is worn only at night while the child is asleep. Patients can go to school and participate in sports normally without their friends even knowing they have scoliosis and wear a brace, avoiding any potential negative stigma.
Many studies have shown that the Charleston Night time brace is as effective as the above-described 23-hour-a-day brace wear.
Curves must be in the 20 to 40 degree range and the apex of the curve needs to be below the level of the shoulder blade for the Charleston brace to be effective.