Neck and Spine Bracing

Neck and Spine Bracing

Summary

Neck and spine braces are used to support the spinal cord and the vertebrae and to treat a number of conditions. The braces are designed to limit movement and allow healing of patients who have had spinal cord injuries or spine surgery. They are also used to correct scoliosis and other deformities in the shape of the spine. Additionally, neck and spine braces may be used in the supportive care of patients with motor neuron diseases, such as amyotrophic lateral sclerosis (Lou Gehrig’s disease).

There are many types of neck and spine braces. They primarily differ in terms of the area of the spine supported and the amount of back, neck and head movement they allow. Braces also differ in the materials they are composed of, how they are affixed to the body and their adjustability. This variety allows physicians to choose the most effective brace to treat the condition, while taking into account the patient’s size, gender and other factors.

Treatment with a neck or spine brace is monitored to measure the patient’s progress. X-rays are used to see how the vertebrae are healing or moving in response to the brace. Through physical therapy, the patient’s muscle function and mobility can be measured and improved. With demonstrated progression towards recovery, the physician may change one type of brace for another before completely removing all support.

Neck and spine braces have the potential to provide significant benefits in the treatment of spinal conditions with limited risks. They speed the healing process, protect the vertebrae from further injury, correct spinal deformities and reduce back pain. When used correctly, the risks of treatment with a brace are usually minor and may include discomfort, muscle and bone atrophy, skin infection, and possible development of psychological dependence after healing is complete.

About neck and spine bracing

Neck and spine braces are external devices that provide support to a person’s spinal cord and vertebrae. The spinal cord is a group of nerves that extend from the brain to the tailbone. They carry messages from the brain to the nerves that control most of the body’s muscles. The spinal cord nerves also receive information from the five senses. A series of vertebrae (the bones that make up the spinal column) surround the spinal cord and allow the back to bend.

The spine is divided into several regions:

  • Cervical.  Seven vertebrae located in the neck
  • Thoracic. Twelve vertebrae located in the upper back
  • Lumbar. Five vertebrae located in the lower back

Below the lumbar vertebrae is the sacrum. This triangular bone makes up the back part of the pelvis. In children, the sacral spine begins as five vertebrae that eventually fuse into the single adult bone. The sacral region also contains the coccyx (tailbone), which is at the bottom of the spine. The coccyx begins as several vertebrae, usually four, that fuse into one adult bone.

Most braces are designed to provide support for particular segments of the spinal column and a physician will recommend the one most appropriate for the patient’s condition and needs.

Braces work in several ways to promote healing and reduce discomfort. They limit the motion of all or part of the spine and reduce the downward pressure exerted on the spine by the head. This helps prevent spinal cord injuries from getting worse while allowing the body to naturally heal. Braces also allow the body time to heal after spine surgery and other medical treatments.

Some medical conditions (e.g., scoliosis) cause deformities in the shape of the spine. Braces may be used to provide a force against the direction of the deformity, which helps prevent progression of the condition and may correct the shape of the spine.

Braces may also be recommended for patients with motor neuron diseases such as amyotrophic lateral sclerosis (Lou Gehrig’s disease). These patients often have muscle weakness and, in some cases, the muscles may fatigue easily with use. Braces may be used to hold the head up and the back straight without straining and fatiguing the muscles that would normally be used.

Types of neck and spine bracing

There are many types of neck and spine bracing available. A physician will recommend the brace most appropriate for the patient’s condition and needs. Many are designed to provide support for certain portions of the spinal column. There are additional factors that may influence which brace is best suited for a patient. These include:

  • Weight
  • Adjustability
  • Cost
  • Durability
  • Material
  • Ease of use

Neck braces, also known as cervical collars, provide stability to the cervical spine and allow the neck muscles to relax by supporting the weight of the head with the shoulders. They are usually used temporarily and the physician may change the type of neck brace during the course of treatment. In some cases, overuse of neck braces may hinder healing from whiplash and other sources of neck pain. Types of neck braces include the following:

  • Soft collar. A foam brace worn around the neck. It is usually used as a transition from a rigid brace to no collar. They are designed to be easily put on and removed.

  • Semi-rigid and rigid cervical collar. Plastic and metal braces that support the chin and the occiput, the bone that forms the back of the head. There are many kinds, including the Philadelphia collar, Miami J collar, Malibu collar and Aspen collar. They vary in price and adjustability. In general, this type restricts head motion more than soft collars and some may have extensions added to support the thoracic spine.

  • Sterno-occipital mandibular immobilizer (SOMI). Supports the chin and occiput with three posts attached to a chest plate affixed with straps that cross the patient’s back. It holds the neck in a straight line to allow it to heal. The patient is unable to bend or twist the neck with a SOMI brace. The chin support can be removed to allow the patient to eat.

  • Halo device. The most rigid of head and neck braces. A metal or composite-material ring, or halo, is attached to the patient’s skull with pins. The halo is supported by four posts (two from the chest, two from the back) attached to a vest worn by the patient. The halo device restricts nearly all neck movement and is usually used to treat severe neck and spinal injuries. The brace is typically worn for three months to allow the vertebrae to heal completely.

Spinal braces provide support to the thoracic spine, lumbar spine and sacrum. These vertebrae are found behind the chest and down into the pelvis and hips. These braces may be recommended for back pain, scoliosis and other conditions. Types of spine braces include:

  • Thoracolumbosacral orthosis (TLS). Plastic body jacket that wraps around the patient from beneath the arms to the lower part of the back. It is custom molded and can be worn under clothes.

  • Chairback brace. Rigid plastic brace that supports the lumbar spine. It covers most of the back below the shoulder blades to the sacrum. This corset-style brace wraps around the patient’s midsection and some types may be custom molded.

  • Knight-Taylor brace. Corset-style front brace with straps around the back and shoulders that limit stretching and bending (flexion) of the spinal column.

  • Cruciform anterior spinal hyperextension (CASH) brace. A device with posts in a lowercase “t” formation that is worn across the patient’s chest to limit flexion and extension of the spine. It has pads at the chest, both sides of the abdomen and the pelvis. A strap runs from one abdominal pad, behind the back, to the other. Some forms have an additional post at the top to distribute the pressure across a greater area of the chest.

  • Jewett hyperextension brace. Similar to the CASH brace in function, but it is shaped like an “O.” Pads are located at the patient’s chest and pelvis and it is attached with straps that wrap behind the lower back.

Before and during neck and spine brace fitting

A neck or spine brace may be recommended by a physician as part of the treatment for a wide variety of conditions and diseases. The physician will recommend a brace that best suits the patient’s condition, taking into account the patient’s age, size and expected treatment course.

A patient who is suitable for neck or spine bracing may be advised to consult a specialist in the field of orthotics. These specialists work to find the best means to make and fit braces to treat patients. In general, before fitting, the patient’s spine will be analyzed by x-ray for comparison later in treatment. Once the appropriate brace is chosen, the patient will be fitted with the brace and provided instructions on how it is worn, adjusted and maintained.

There is no single procedure for fitting a patient with a brace because there is such a wide range of spinal conditions and braces available. While most braces are fitted easily and designed to be put on and removed by the patient, some braces may require specialist fitting and maintenance.

After neck and spine brace fitting

It is important that patients undergoing treatment with a neck or spine brace follow the physician’s instructions after the brace is fitted. In order for the brace to be effective, it must be fitted and maintained correctly. Otherwise, the brace may not provide proper support and the patient may suffer further injury. Patients should consult their physician about how to wear and maintain their brace.

Regular physician visits are necessary to monitor the progress of the treatment. This is likely to include additional x-rays.

Physical therapy is usually a part of the treatment regime for many spine and neck injuries. This helps the patient maintain muscle strength, which may be lost as a result of periods of inactivity during the healing process. It may also help the patient regain mobility and reduce the chance of future injury.

The physician may change the type of brace during the course of the treatment. For example, as patients with injuries to the cervical spine show progress toward complete recovery, the physician may choose to change from a rigid to a soft cervical collar. This collar allows more movement and forces the patient to use the neck muscles more than any of the other braces.

After the removal of the brace, further x-rays and physical therapy may be required to ensure that the patient’s recovery is as complete as possible.

Potential benefits and risks of neck and spine bracing

Neck and spine braces are used to treat a number of conditions and diseases. They are routinely used for patients with scoliosis or following spinal cord injuries and spine surgery. They are generally recommended by physicians because they are usually the most effective form of treatment with the fewest complications. The benefits of neck and spine braces include:

  • Faster healing
  • Protection against instability of vertebrae
  • Correction of deformities in spinal curve
  • Less back pain and improved function
  • Increased strength

There are a few risks involved in using neck or spine braces, although most are minor. The most common risk associated with neck and spine braces is the likelihood of discomfort and localized pain. However, the benefits of wearing a neck or spine brace usually outweigh the potential for discomfort. Other risks associated with neck and spine braces include:

  • Loss of bone density and muscle atrophy
  • Skin infection
  • Ingrown facial hair on men due to chin padding
  • Increased energy requirement due to weight of device
  • Psychological dependency on the brace after recovery

Patients should consult their physician about what to expect during treatment with a neck or spine brace.

Questions for your doctor about neck and spine bracing

Preparing questions in advance can help patients to have more meaningful discussions with healthcare professionals regarding their condition. Patients may wish to ask their doctor the following neck and spine-related questions:

  1. Can my condition be treated with a neck or spine brace?

  2. Are there other options to treat my condition?

  3. What type of brace do I need?

  4. Can you recommend a specialist for my brace?

  5. How do I wear the brace?

  6. How often and how long do I need to wear the brace?

  7. Are there risk factors associated with the brace?

  8. How can you tell that the brace is working?

  9. Can I bathe, eat, dress and perform other regular daily activities as normal with the brace? If not, how do I need to change?

  10. Will I have a full recovery by using the brace?

  11. How will I know if I have become dependent on my brace?
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