Spine Bracing Provides Pain Relief in Patients Awaiting Elective Surgery
During the COVID-19 pandemic, physicians, surgeons, and orthotists can work together to provide optimal care for patients who have had their elective spinal procedures disallowed or postponed. Spinal bracing is a low-risk, cost-effective method to treat spinal pain, injury, or degenerative diseases, and has been proven to offer equivalent injury or pain management efficacy if surgical procedures are delayed or cannot be provided.1
When determining whether a patient may benefit from a spinal orthosis, it is important to understand the three main treatment categories:
Pain in the neck, thorax, or low back can be reduced by the use of an appropriate orthosis. Most clinicians recognize that pain relief with orthoses works by reminding the patient to avoid extreme, abrupt, stressful movements, and promote rest for affected anatomic structures. Orthoses may also limit the range in which the patient can move and foster a more satisfactory vertebral alignment. These functions can lessen pain by minimizing faulty muscle action.
2. Trauma and Post-Op Care
The use of orthoses following surgery or spinal trauma varies considerably depending on the type of surgery, the particular injury that has occurred, and whether or not surgical stabilization has been performed.
Orthoses serve several purposes in the treatment of spinal trauma and can be used as a solution for either short-term or longer-term treatment plans. The external support of the orthosis can help to reduce pain as well as provide some added stability while fractures and soft tissue injuries heal. In addition, orthoses can help to prevent deformity during the healing phase of the injury, reduce spinal tension and reduce the motions such as twisting or spinal flexion that delay healing, as well as increase overall stability of the spine.
In 2014, a re-published case study by Wood et al. described a prospective, randomized study comparing operative to non-operative treatment for thoracolumbar burst fractures.1 The study enrolled 53 patients–26 patients were randomized to the operative arm and 27 patients to the non-operative arm. Follow up occurred for up to 2 years, and the results showed the non-operative patients using a custom thoracolumbosacral orthosis placed in hyperextension for 8-12 weeks were found to have no differences in radiographic findings between the operative and non-operative treatment arms. These findings suggest that treatment with a spinal orthosis may be beneficial for patients who are in need of surgery but cannot schedule a procedure due to the COVID-19 pandemic.
The use of spinal orthoses for the treatment of spinal deformities is ever-evolving. The treatment of spinal deformities with an orthosis most commonly involves adolescent idiopathic scoliosis, congenital neuromuscular scoliosis, and Scheuermann’s disease. In the adult population, most spinal deformities are the result of degenerative changes over time resulting in postural changes, decreased activities, and pain. Recently, evolutions in orthosis treatments are showing promise in the management of the adult spinal deformities and pain.
Types of Spinal Orthoses
There are two types of spinal orthoses, both of which are ordered by prescription: prefabricated (or off-the-shelf) and custom.
Most patients who need spinal orthoses are fitted with prefabricated orthoses ordered according to measurements. Used for a broad range of indications, prefabricated orthoses are commonly stocked in your local Orthotist’s facilities. To ensure these devices are fit appropriately, patients should be evaluated by an Orthotist and re-checked on a regular basis.
When prefabricated orthoses will not fit or function optimally, a custom device may be used. Custom-made orthoses are molded to the patient and are often considered preferable and more effective. In many cases, they provide a better fit, alignment, and structural support, helping patients achieve positive outcomes for varying treatment needs.
Whether prefabricated or custom, a common nomenclature has been developed by the Committee on Prosthetics-Orthotics Education (CPOE) to describe spinal orthoses and should be used when prescribing treatment:
- SIO, sacroiliac orthosis
- LSO, lumbosacral orthosis
- TLSO, thoracolumbosacral orthosis
- CO, cervical orthosis
- HCTO, head-cervical-thoracic orthosis
Benefits & Considerations
Like any treatment, there are risks and benefits to be considered. The beneficial effects vary based on the indication, with the most common being:
- Trunk Support – Accomplished by two mechanisms: a three-point pressure system and an abdominal section. The abdominal section increases the effectiveness of the abdominal muscles in elevating intracavitary pressure.
- Motion Restriction – May help to reduce pain and provide stability while fractures and inflamed soft tissues heal. A spinal orthosis is often worn for 6-12 weeks to allow a spinal fracture to heal.
- Modification of Skeletal Alignment – Often seen with an orthosis used in the intervention for a spinal deformity, such as scoliosis or kyphosis.
Some of the potential considerations and contraindications to keep in mind are muscle atrophy and possible weakness, joint contracture after a period of immobilization, hypermobility in areas above or below the immobilized areas, respiratory difficulties due to compression, and poor cosmetic appearance.
Hanger Clinic’s Expertise
With over 800 locations across the country, we are available to provide your patients with the care they need, when they need it. Our team of over 1,500 highly-trained clinicians adheres to established Clinical Practice Guidelines that follow a multistep development process and are based upon the best available evidence. We are also in-network with more than 2,500 insurance providers, helping patients get access to the orthotic care they need.
- Wood, Kirkham B., et al. “Management of Thoracolumbar Spine Fractures.” The Spine Journal, vol. 14, no. 1, 2014, pp. 145–164., doi:10.1016/j.spinee.2012.10.041.
This post was developed by Eric Weber, CPO, in collaboration with Chris Toelle, a board-certified orthotist and Area Clinic Manager for Hanger Clinic.
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