Spinal Orthoses: Thoracic-Lumbar-Sacral (TLSO), Lu

This section addresses the use of back braces that are designed to immobilize or support various levels of the spine to treat back conditions.



Non-Surgical Treatment of Spondylosis (Spinal Arthritis) PDF Print E-mail

Introduction:

Most cases of spondylosis are mild and require little if any treatment. In more aggressive forms of the disease, especially in the cervical spine, the goal of treatment is to relieve pain and prevent spinal cord and nerve root injury. The more common non-surgical treatments are summarized below.

Acupuncture

Acupuncture is a popular treatment used to help alleviate back and neck pain. Tiny needles, about the size of a human hair, are inserted into specific points on the body. Each needle may be twirled, electrically stimulated, or warmed to enhance the effect of the treatment. It is believed that acupuncture works (in part) by prompting the body to produce chemicals that help to reduce pain.

Bed Rest

Severe cases of spondylosis may require bed rest for no more than 1-3 days. Long-term bed rest is avoided as it puts patient at risk for deep vein thrombosis (DVT, blood clots in the legs).

Brace Use

Temporary bracing (1 week) may help relieve symptoms, but long-term use is discouraged. Braces worn long-term weaken the spinal muscles and can increase pain if not constantly worn. Physical therapy is more beneficial as it strengthens the muscles.

Cervical Traction

In most cases, spinal traction is rarely needed or used to alleviate symptoms associated with spondylosis. Intermittent traction therapy may be included with the use of a brace. Periodic cervical traction incorporates the use of a halter-type device worn about the head and neck that is attached to a weight. The weight causes distraction and gently pulls to help relieve nerve compression and pai

Chiropractic

Chiropractors believe that a healthy nervous system is synonymous with a healthy body. A subluxation, or the misalignment of a vertebra, may distress the nervous system and lead to a disorder causing back and neck pain. Chiropractors do not prescribe drugs or use surgery. Their practice includes ice/heat, ultrasound, massage, lifestyle modification, and spinal adjustments -- also called spinal manipulation.

Lifestyle Modification

Losing weight and maintaining a healthy weight, eating nutritious foods, regular exercise, and not smoking are important 'healthy habits' to help spine function at any age.

Muscle Relaxants: Muscle relaxant medication helps to alleviate muscle spasm and pain.

Narcotics: Narcotics (opioids) may be prescribed for short periods of time to reduce acute pain.

NSAIDs: Non-steroidal anti-inflammatory drugs (NSAIDs) relieve inflammation that often contributes to pain. Many NSAIDs are available over-the-counter (OTC) and others by prescription only. Do not combine OTC medications with prescription drugs without the physician's permission. Doing so may cause a serious and adverse affect.

Physical Therapy

Physical therapy combines passive treatments with therapeutic exercise. Passive treatment modalities include heat/ice, ultrasound and electrical stimulation to alleviate muscle spasm and pain. Therapeutic exercises teach the patient how to increase flexibility and range of motion while building strength. Patients need not be fearful of physical therapy. Even patients experiencing pain and great difficulty moving have found that isometric exercises are beneficial.

Spinal Injections
There are many types of spinal injections including epidural steroid injections and facet joint injections. These injections combine a local anesthetic and steroid medication to reduce inflamed nerve tissues and thereby often help to reduce pain.

Seldom is Surgery Needed
Very few patients with spondylosis require surgery. When surgery is necessary, seldom is it an emergency. Non-operative therapy is tried first. The physician may determine that combining two or more therapies may benefit the patient to quickly resolve their symptoms. In most cases, non-surgical treatments work.

However, some patients suffer neurologic deficit - such as weakness, incontinence, or develop structural spinal instability. The cause of severe symptoms often determines the type of surgery needed. For example, it may be necessary to surgically remove bone spurs or disc tissue compressing spinal nerves or causing spinal cord compression. Depending on the extent of the surgery, spinal fusion to stabilize the spine may be necessary. Fortunately, newer minimally invasive spine surgical techniques greatly benefit patients. Minimally invasive spine surgery enables patients to return to normal activities sooner.

Conclusion
Patients with chronic back pain are urged to seek the advice of a spine specialist. The all-important first step to relieve back and neck pain is to obtain a proper diagnosis. Back pain can be caused by many problems including spinal stenosis, fibromyalgia, spondylolisthesis, osteoporosis, compression fractures, and bone tumors. The in-depth and specialized training spine physicians receive equips them to treat a variety of disorders causing back and neck pain.

 

 

Article Source: http://www.spineuniverse.com/conditions/spondylosis/non-surgical-treatment-spondylosis-spinal
Written by: Written by Praveen V. Mummaneni, MD and Susan Spinasanta
 
General Description - Spinal Brace/Orthotics PDF Print E-mail

General Background - Spinal Orthotics

Back pain is a common ailment that affects individuals of all ages and may result from conditions including, but not limited to, injury, obesity, age, disc disease, spinal stenosis, spinal sprains and strains. Back pain treatments include short-term rest, nonsteroidal anti-inflammatory drugs, muscle relaxants, back braces/spinal orthotics and passive modalities such as heat, cold, massage, ultrasound, electrical stimulation, acupuncture, traction, and spinal manipulation. More invasive treatments may involve anesthetic injections and surgery.

Orthotic devices are orthopedic appliances or apparatuses used to support, align, prevent or correct deformities. A brace is an orthosis or orthopedic appliance that supports or holds in correct position any movable part of the body and that allows for motion of that body part. A spinal orthosis provides an external force to control spine position, applies corrective forces to abnormal curvatures, provides stabilization of spine structures when soft tissue can’t, and restricts spine movement after trauma. The biomechanics typically consist of a three-point pressure system directed at trunk and head support, motion control, spinal realignment and partial weight transfer when upright. Spinal orthoses include cervical orthoses (CO), cervical-thoracic orthoses, (CTO), thoracic orthoses (TO), thoracic-lumbar-sacral orthoses, (TLSO), lumbar-sacral orthoses (LSO), and lumbar orthoses (LO).

Spinal orthoses have been recommended for conservative treatment of back pain and to stabilize the spine. Conditions for which spinal orthoses have been recommended for relieving pain, reducing progression of disease/injury, and improving function include but are not limited to spinal stenosis, vertebral fractures, scoliosis, spondylosis, spondylolisthesis, Scheuermann’s disease (kyphotic deformity), and sprains.

Lumbosacral supports or back braces have also been used for the treatment of back pain related to degenerative disorders of the lumbar spine, as a predictor of outcome following lumbar fusion surgery, and as an adjunct to lumbar fusion surgery. According to a review and subsequent guideline published by Resnick et al. (2005), the current evidence is insufficient to recommend a treatment standard. However, the following are recommended guidelines/options for brace therapy as an adjunct to or substitute for lumbar fusion:

  • The short-term use of a rigid lumbar support (i.e., 1–3 weeks) is recommended as a treatment for low-back pain of relatively short duration (i.e., < six months).

  • The use of a lumbar brace for patients with chronic low-back pain is not recommended because there is no pertinent medical evidence of any long-term benefit or evidence that brace therapy is effective in the treatment of patients with chronic (i.e., > six months) low-back pain.

  • Lumbar braces are not recommended as a means of decreasing low-back pain in the general working population; however, they are recommended as a means of decreasing the number of sick days lost due to low-back pain among workers with a previous lumbar injury.

  • The use of lumbar brace therapy as a preoperative diagnostic tool or transpedicular external fixation to predict outcome following lumbar fusion surgery is not recommended.

Spinal orthoses have also been recommended for use following spinal surgery as a method of restricting excessive spinal motion, allowing for soft tissue healing, and to reduce postoperative pain. In addition, spinal bracing results in lower incidence of hardware failure, loss of surgical correction, and pseudoarthrosis. The indications for bracing are dependent on the degree of injury and spinal instability, the presence of neurological deficit, the type and quality of internal fixation, bone quality, and the patient's individual profile.

Combined with education and training on back mechanics and lifting, elastic rib belts and lumbar supports have been recommended for the prevention of injury in the workplace.

Types of Spinal Orthoses:

Corset braces:

Corsets, a type of spinal brace commonly used to treat low back pain. If you'd like to read a comprehensive article about all types of spinal bracing, please read our spinal bracing overview.

Low back pain can be caused by a number of things. Corset braces are often prescribed to treat low back pain associated with:

  • degenerative disc disease

  • trauma, fracture, or injury

  • spinal deformity (such as scoliosis)

A corset brace may also be used to immobilize your back after spine surgery.

What Does a Corset Brace Look Like?

 

Corset.jpg (14781 bytes)

 

A corset brace is fairly easy to visualize. It looks similar to the corsets women wore centuries ago. Corset braces are tightened using laces that can be tied in the back, front, or side. In most cases, these braces are made of cotton or nylon. And unlike its fashionable counterpart, corset braces are actually quite comfortable.

Corset braces are held up with straps that go over the shoulder. From the front, the corset usually covers the area from the sternum down to the pelvic area. From the back, it covers from the shoulder down to below the buttocks.

 

 

 

 

 

How Does a Corset Brace Work?
Corsets work by increasing the pressure in the abdomen, thus reducing the amount of weight placed on sensitive spinal structures, such as vertebrae and joints. By reducing the stress on these structures, it creates an environment that allows your spine to heal faster.

Though the corset brace is made of lightweight cloth, it may contain metal bars that provide rigid reinforcements to prevent movement and help improve posture. These bars may be added or removed based on your specific treatment needs. For instance, if you need a brace to help you recover from lumbar spine surgery, the metal bars will restrict movement and allow the sensitive surgical area to heal easier.

Special Considerations
As with all spinal braces, the effectiveness of a corset brace is dependent on how well it has been tailored to you. In other words, bracing isn't a one-size-fits-all treatment. It's essential that your brace fits you properly.

Fortunately, there are specialists known as orthotists who will ensure that your corset brace is created just for you. There's also no standard length of time that you will wear the brace. How long you'll wear the corset brace varies among patients, so always follow your doctor's specific instructions. He or she will show you how to care for the brace and make specific recommendations to maximize the effectiveness of the treatment.

Hyperextension Braces:

Hyperextension braces are commonly used to treat spinal compression fractures and help your back recover after spine surgery. This article will focus on hyperextension braces, though there are many other types of spinal braces (which your doctor may call orthotics or orthoses). To read a general bracing treatment article that describes all spinal bracing options, please read our spinal bracing overview.

What Does a Hyperextension Brace Look Like?
Hyperextension braces are used to treat fractures and back pain that occur where the thoracic spine (upper back) meets the lumbar spine (low back). It is designed to limit movement in these 2 regions of the spine.

To limit front bending, a hyperextension brace features a rectangular metal frame that goes over the front of the body. This frame puts pressure on the chest and pubic bone. Because a hyperextension brace is primarily used to treat spinal compression fractures that occur where the upper back meets the low back, this brace also puts pressure and support on the thoracic spine. This pressure keeps the spine in an extended position.

A hyperextension brace also features 3 pads that help stabilize the spine and prevent forward movement. One pad is located along the abdominals, another is higher up on the chest, and the third pad is on the back and covers the affected area.

 

 Hyperextension Orthosis 28R15 from Otto Bock.

How Does a Hyperextension Brace Work?
Hyperextension braces prevent you from bending forward too much. In turn, this prevents you from potentially interfering with the healing of your spinal compression fracture and sensitive spinal structures.

This type of spinal brace may also be prescribed if you've just had spine surgery involving the thoracic or upper lumbar region of the spine. A hyperextension brace will take the pressure off of weak vertebrae and ensure that you don't bend too far forward.

Though hyperextension braces restrict bending of the spine, you may still bend to the side and rotate.

Special Considerations
If you are recovering from spinal compression fractures or spinal surgery, your doctor may recommend adding a hyperextension brace to your treatment plan. You will visit with an orthotist, a specialist who designs spinal braces. He or she will make sure that your hyperextension brace fits you properly, which is vital to the effectiveness of the brace. Bracing is a very personal treatment option. In other words, there are few general guidelines when it comes to using a brace. That's why it's so important that you follow your doctor's specific instructions for you.

Molded Jackets:

A molded jacket, also called a thoracolumbosacral orthosis (TLSO), provides rigid stabilization to treat a number of spinal conditions, including spinal fractures and scoliosis. This article is specifically about molded jackets. If you'd like to learn about all the different types of spinal braces, please read our spinal bracing overview.

A molded jacket is a total-coverage brace. What that means is that this spinal brace supports a large area—it covers the thoracic spine (upper back), lumbar spine (low back), and sacrum.

This type of spinal brace provides a strong external support for your thoracic and lumbar regions. As such, molded jackets may help treat a variety of spinal conditions, including:

  • spinal fractures (including burst fractures and spinal compression fractures)

  • scoliosis

  • Scheuermann's kyphosis

  • ankylosing spondylitis

Your doctor may also prescribe a molded jacket to limit movement and promote healing after spine surgery.

What Does a Molded Jacket Look Like?
A molded jacket is made of a hard, lightweight plastic shell with a soft inner lining for comfort. Some molded jackets are single-piece braces that come with one opening. Others come in 2 pieces with openings on both sides of the jacket (this design is often called the clamshell).

As the name implies, a molded jacket is molded to your body. A specialist called an orthotist will specially design and custom fit the molded jacket for you. To customize the fit, your orthotist will likely use digital technology to accurately craft the mold for your brace. Plaster of Paris may also be used to create a cast, though this method is more outdated.

ag_250400delray_jacket-BB

How Does a Molded Jacket Work?
A molded jacket controls movement in all directions—front, back, and side. It also limits how far you can rotate. By restricting mobility, a molded jacket prevents further damage to spinal structures that are trying to heal. The rigidity of the brace may also prevent the progression of deformity in patients with scoliosis or kyphosis.

A molded brace also encourages healing by increasing pressure in your abdomen and chest. This, in turn, reduces the pressure on your spine.

Special Considerations
Molded jackets can provide non-surgical treatment for a variety of spinal disorders. But as with any treatment, it's essential that you follow your doctor's specific instructions. Patients typically wear a molded jacket for 3 months, but your doctor may recommend a different length of wear for you based on your condition. If you have any questions about how to care for your spinal brace—or if you'd like more information on how your brace may improve your condition—don't hesitate to ask your doctor or orthotist.

Neck Braces

If you require cervical spine surgery, or if you've experienced trauma or injury to your neck, you may need to wear a neck brace. Neck braces are among the most common of all spinal braces (which your doctor may call orthoses or orthotics). There are many kinds of neck braces, and the most common ones are outlined below. If you'd like to read a general article that describes all the types of spinal braces, please read our spinal bracing overview.

Neck braces, which are also called collars, serve a variety of purposes. They can stabilize your neck after cervical spine surgery, or they can provide non-surgical relief if you've experienced trauma or injury to your neck (from whiplash, for instance).

This article will cover the most commonly prescribed neck braces:

  • Soft and Hard Collars

  • Philadelphia Collar

  • Sterno-occipital-mandibular Immobilization Device (SOMI)

  • Halo

Soft and Hard Collars

Soft collars are flexible and made of polyurethane foam rubber. These collars are easily wrapped around the neck and secured with Velcro. Soft collars are usually worn after wearing a more rigid collar, so most of the healing will be complete by the time you begin wearing a soft collar. The main purpose of a soft collar is to help you gradually transition to not wearing a brace.

Hard collars look similar to soft collars, but they are made of a hard polyethylene material. These collars may provide support and pain relief for a variety of spinal conditions, including cervical spondylosis and acute neck pain.

neck_collar-EE

Cervical Collars

Philadelphia Collar
A Philadelphia collar is a stiff foam collar composed of 2 pieces that are attached on the sides with Velcro.

The upper portion of the Philadelphia collar supports the lower jaw and the brace extends down to cover the upper thoracic spine. This collar covers more area than a soft or hard collar, so it puts greater restrictions on your range of motion.

Because it's so effective at limiting movement, the Philadelphia collar is often prescribed after cervical spine surgery to promote a healthy recovery. It's also commonly used to stabilize minor cervical spinal fractures and reduce pain associated with muscle strain in the neck.

ebicollar-BBPhiladelphia Collar

Sterno-occipital-mandibular Immobilization Device (SOMI)

A sterno-occipital-mandibular immobilization device (SOMI) is a rigid cervical brace that positions your neck in straight alignment with your spine. This brace supports your neck by preventing your head and neck from moving. This level of immobility will allow the damaged structures in your neck to heal faster.

The name of this brace gives an indication of its structure. Sterno comes from sternum, which is in your chest. This rigid brace has a front chest plate, along with bars that go over the shoulder. The brace is secured with straps on the bars that attach to opposite sides of the front chest plate. There are no bars that go along your back. The SOMI brace also has a removable chin piece (mandibular comes from mandible, which is your lower jawbone) and optional headpiece for added support (occipital refers to the occipital bone at the back of your head).

The SOMI brace may be used as a treatment for a severe neck injury or for cervical pain caused by a chronic condition, such as rheumatoid arthritis. It may also be prescribed as a recovery aid after cervical spine surgery.

Halo

A halo device is the most rigid of all neck braces. It prevents the head and neck from moving, and it may be necessary to immobilize the spine after a major cervical spine procedure or to stabilize fractures in the cervical and/or thoracic regions.

Halo bracing is a form of spinal traction. Traction essentially pulls your spine in two different directions. This tension helps reduce the abnormal curvature associated with some spinal conditions, including scoliosis.

A halo brace features a metal ring that is secured to your head using metal pins. The ring is then connected to 4 bars that are attached to a heavy vest (the weights of halo vests vary). You will wear the halo brace at all times until you are healed.

If you'd like to learn more, please read our article about halo bracing.

Special Considerations
Like all spinal braces, neck braces are most effective when you use them as directed by your doctor. You will also work with an orthotist, a specialist who designs and custom fits spinal braces. If you have any questions about how to wear and care for your brace, don't hesitate to ask your doctor or orthotist. He or she is there to ensure that you understand how to get the most benefit from your treatment.

Rigid Braces

Rigid braces may be used to treat low back pain. They are also commonly prescribed to stabilize your lumbar spine after surgery. There are many types of spinal braces (which your doctor may call orthotics or orthoses), and this article will describe rigid braces. If you'd like to read a more general article about all the types of spinal braces, please read our spinal bracing overview.

There are many different types of rigid braces available, but they share a common structure. They usually have metal or plastic uprights (vertical posts) in the back that mirror the shape of your low back and pelvis. Rigid braces also have bands that lay across your thoracic spine (or upper back). To help transfer weight off your spine, these braces feature fabric straps that place pressure on the abdomen.

Rigid braces are known as lumbosacral orthoses because they treat conditions of the lumbar spine and sacrum. This article will cover the most commonly prescribed rigid braces. These include the:

  • chairback brace

  • Raney flexion jacket

  • Williams brace

Chairback Brace

A chairback brace is a short brace that may provide low back pain relief and spinal stability after surgery. This brace restricts your ability to bend (front, back, and to the sides) and limits how much your low back can rotate.

ag_250400delray_chairback-BB

Raney Flexion Jacket

The Raney flexion jacket reduces pressure and weight on the low back by securing the lumbar spine in a neutral tilt. This creates more pressure in the abdomen, which lessens the weight on the low back. The fixed tilt also helps prevent the progression of lordosis. Lordosis is a condition characterized by an abnormal, inward curve of the lumbar spine.

Williams Brace

The Williams brace is commonly prescribed to limit movement in patients with spondylolysis or spondylolisthesis. This rigid brace has a front elastic band, so you can bend forward, but side uprights limit how much you can bend from side-to-side. The Williams brace also limits extension.

Special Considerations
Regardless what rigid brace you need, your brace will be custom fit by an orthotist (a specialist who designs and fits braces). Ensuring that your brace fits you perfectly is so important. Also important is that you follow your doctor's specific instructions for the wear and care of your spinal brace. If you're unsure about any aspect of your bracing treatment, call your doctor and/or orthotist.

Sacroiliac and Lumbosacral Belts

Sacroiliac and lumbosacral belts are back braces that help treat pain in the lumbar spine and sacrum. There are spinal braces (which your doctor may call orthotics or orthoses) for every region of the spine, but this article will focus solely on sacroiliac and lumbosacral belts. To read a comprehensive article about all the different types of spinal braces, please read our spinal bracing overview.

Sacroiliac Belts

Your doctor may prescribe a sacroiliac belt if you have sacroiliac joint pain. The sacroiliac joints, which are often called SI joints, are located on both sides of your sacrum (the base of your spine). Your SI joints connect the sacrum to the pelvis, and we have a video on the sacroiliac joints to help you learn more.

Like all joints, the sacroiliac joints are encased in strong ligaments. Healthy ligaments prevent the SI joints from moving too much. But if the ligaments become diseased (from osteoarthritis, for instance), injured, or worn down by age, they allow the SI joints to move more than they should. This can cause pain in your pelvis and low back. A condition called sacroiliac joint dysfunction can also cause low back pain.

A sacroiliac belt provides compression around the hip to prevent the SI joints from moving excessively. The belt is wrapped around the pelvis and may be tightened using laces on the side or back of the brace.

Lumbosacral Belts

Lumbosacral belts are designed to provide pressure on your abdominals, thereby reducing weight and stress on your low back. This type of brace provides lumbar spine stabilization, so it creates an optimal healing environment for a number of lumbar spine conditions, including low back muscle strain.

Made of sturdy cotton, lumbosacral belts are wrapped around your waist and can be easily adjusted using laces on the side or back. Lumbosacral belts are available in a variety of sizes to provide the right amount of support for different low back conditions.

Special Considerations
It's essential that you follow your doctor's specific instructions for the wear and care of your spinal brace. Whether you need a lumbosacral belt or sacroiliac belt for your low back pain, you should understand that the brace is most effective when you wear it according to your doctor's orders. You may also consult with your orthotist if you have any questions. He or she specializes in the design and fit of spinal braces, so don't hesitate to contact your orthotist if you're unsure about any aspect of your bracing treatment.

Trochanteric Belts

A trochanteric belt, like a sacroiliac belt, is a spinal brace that helps treat sacroiliac joint pain. Spinal braces are also called orthotics or orthoses, and there are different bracing types that treat a number of spinal conditions.

 

What Does a Trochanteric Belt Look Like?
A trochanteric belt is similar to a regular belt in that it buckles in front. Unlike regular belts, you wear the trochanteric belt underneath your garments. Fortunately, this brace is not bulky; it's discreet and comfortable.

The trochanteric belt is about 3 inches wide and fits snuggly around your pelvis. Specifically, it's placed between the trochanters (bony structures located at the top of the thigh bone) and the iliac crests (the outside portion of each side of the pelvis).

How Does a Trochanteric Belt Work?
Trochanteric belts compress and stabilize painful sacroiliac joints. The sacroiliac joints (SI joints) are located on both sides of your sacrum (the base of your spine). Your SI joints connect the sacrum to the pelvis. This video on the sacroiliac joints will help you learn more about these structures.

The sacroiliac joints are protected by strong ligaments. Healthy ligaments ensure that the SI joints don't move very much. But if the ligaments become diseased, injured, or worn down by age, then the SI joints will move more than they should. This can cause pain in your pelvis and low back.

A trochanteric belt may not only reduce sacroiliac joint and low back pain, but it may also help stabilize pelvic fractures. By restricting movement in the area, the brace allows the fractures to heal properly.

Special Considerations
As with any spinal brace, the effectiveness of the trochanteric belt is largely dependent on whether you follow your doctor's specific instructions for you. Bracing is a very personal spinal treatment in that there's no one-size-fits-all prescription. Your doctor and orthotist (a specialist who designs and fits braces) will work together to ensure that your bracing treatment is customized to give you the best results possible.

 

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Coding/Billing Information

Note: This list of codes may not be all-inclusive.
Covered when medically necessary:

If you need information regarding DME Billing Code Click Here. Diagnosis Code Click Here

HCPCS Codes

L0120

Cervical, flexible, nonadjustable (foam collar)

L0130

Cervical, flexible, thermoplastic collar, molded to patient

L0140

Cervical, semi-rigid, adjustable (plastic collar)

L0150

Cervical, semi-rigid, adjustable molded chin cup (plastic collar with mandibular/occipital piece)

L0160

Cervical, semi-rigid, wire frame occipital/mandibular support

L0170

Cervical, collar, molded to patient model

L0172

Cervical, collar, semi-rigid thermoplastic foam, two piece

L0174

Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension

L0180

Cervical, multiple post collar, occipital/mandibular supports, adjustable

L0190

Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars (SOMI, Guilford, Taylor types)

L0200

Cervical, multiple post collar, occipital/mandibular supports, adjustable cervical bars, and thoracic extension

L0220

Thoracic, rib belt, custom fabricated

 

L0430

Spinal orthosis, anterior-posterior-lateral control, with interface material, custom fitted (DeWall Posture Protector only)

L0450

TLSO, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, includes fitting and adjustment

L0452

TLSO, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, custom fabricated

L0454

TLSO flexible, provides trunk support, extends from sacrococcygeal junction to above T-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, includes fitting and adjustment

L0456

TLSO, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, includes fitting and adjustment

L0458

TLSO, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0460

TLSO, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0462

TLSO, triplanar control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0464

TLSO, triplanar control, modular segmented spinal system, four rigid plastic shells, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment

L0466

TLSO, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

L0468

TLSO, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment

L0470

TLSO, triplanar control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction to scapula, lateral strength provided by pelvic, thoracic, and lateral frame pieces, rotational strength provided by subclavicular extensions, restricts gross trunk motion in sagittal, coronal, and transverse planes, produces intracavitary pressure to reduce load on the intervertebral disks, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment.

L0472

TLSO, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes fitting and shaping the frame, prefabricated, includes fitting and adjustment.

L0480

TLSO, triplanar control, one piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated

L0482

TLSO, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated.

L0484

TLSO, triplanar control, two piece rigid plastic shell without interface liner, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated.

L0486

TLSO, triplanar control, two piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, lateral strength is enhanced by overlapping plastic, restricts gross trunk motion in the sagittal, coronal, and transverse planes, includes a carved plaster or CAD-CAM model, custom fabricated.

L0488

TLSO, triplanar control, one piece rigid plastic shell with interface liner, multiple straps and closures, posterior extends from sacrococcygeal junction and terminates just inferior to scapular spine, anterior extends from symphysis pubis to sternal notch, anterior or posterior opening, restricts gross trunk motion in sagittal, coronal, and transverse planes, prefabricated, includes fitting and adjustment.

L0490

TLSO, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures, posterior extends from sacrococcygeal junction and terminates at or before the T9 vertebra, anterior extends from symphysis pubis to xiphoid, anterior opening, restricts gross trunk motion in sagittal and coronal planes, prefabricated, includes fitting and adjustment.

L0491

TLSO, sagittal-coronal control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment.

L0492

TLSO, sagittal-coronal control, modular segmented spinal system, three rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the xiphoid, soft liner, restricts gross trunk motion in the sagittal and coronal planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated, includes fitting and adjustment.

L0621

Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated,includes fitting and adjustment.

L0622

Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated.

L0623

Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0624

Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels placed over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, custom fabricated.

L0625

Lumbar orthosis, flexible, provides lumbar support, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, includes fitting and adjustment.

L0626

Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0627

Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from L-1 to below L-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0628

LSO, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0629

LSO,flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, custom fabricated.

L0630

LSO, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0631

LSO, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, pendulous abdomen design, prefabricated, includes fitting and adjustment

L0632

LSO, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated.

L0633

LSO, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0634

LSO, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, custom fabricated.

L0635

LSO, sagittal-coronal control, lumbar flexion, rigid posterior frame/panel(s), lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0636

LSO, sagittal-coronal control, lumbar flexion, rigid posterior frame/panels, lateral articulating design to flex the lumbar spine, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, anterior panel, pendulous abdomen design, custom fabricated.

L0637

LSO, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0638

LSO, sagittal-coronal control, with rigid anterior and posterior frame/panels, posterior extends from sacrococcygeal junction to T-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, custom fabricated.

L0639

LSO, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, includes fitting and adjustment.

L0640

LSO, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to T-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, custom fabricated.

L0970

TLSO, corset front

L0972

LSO, corset front

L0974

TLSO, full corset

L0976

LSO, full corset

L0978

Axillary crutch extension

L0980

Peroneal straps, pair

ICD-9-CM Diagnosis Codes

Description

721.3

Lumbosacral spondylosis without myelopathy

721.42

Spondylosis with myelopathy, lumbar region

724.01

Spinal stenosis of thoracic region

724.02

Spinal stenosis of lumbar region

724.1

Pain in thoracic spine

724.2

Lumbago

724.3

Sciatica

724.4

Thoracic or lumbosacral neuritis or radiculitis, unspecified Multiple/varied codes

 

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Original Article Reference: http://www.spineuniverse.com/treatments/bracing

 

 
General Description - Bracing for Scoliosis PDF Print E-mail

Bracing for Scoliosis

The main goal of a brace in scoliosis is to prevent further deformity, as well as to prevent or delay the need for surgery. If surgery is needed, delaying the procedure as long as possible helps to optimize spinal height and avoid stunting of truncal growth.

Assessing the degree of skeletal maturity in a child with scoliosis is important; with more advanced skeletal maturity, a reduction in skeletal growth and, consequently, a reduction in the progression of the scoliosis would be expected. This has obvious implications when forming a treatment plan.

Risser classification of ossification of the iliac epiphysis is used to evaluate skeletal immaturity. Ossification of the iliac crest occurs from the anterior superior iliac spine (ASIS) to the posterior superior iliac spine (PSIS). When ossification is complete, fusion of the epiphysis occurs to the iliac crest. Risser staging is based on the use of radiographs to determine what percentage of the excursion (along the length of the iliac epiphysis) has ossified. A Risser score of 0-I with a curve of 20-30° indicates a nearly 70% chance of progression.

Risser stages are defined as follows:

  • Stage 0 - 0% excursion
  • Stage I - 25% excursion
  • Stage II - 50% excursion
  • Stage III - 75% excursion
  • Stage IV - 100% excursion; correlates with the end of spinal growth
  • Stage V - Fusion to the ilium, indicating the cessation of vertical height growth

The clinician must take into account several bits of clinical information about the use of braces in scoliosis, including the following:

  • Only 3% of patients with prebrace curves of 20-29° require surgery, whereas 28% of patients with prebrace curves of 40-49° require surgery.
  • Patients younger than 13 years with a 30-39° curvature require surgery 25% of the time, while surgery is needed in only 14% of patients who are older than 14 years and have a 30-39º curvature.
  • The most common time to lose control of idiopathic curves is at puberty. Boys tend to show less curve progression than do girls. Boys also tend to have a later onset of curve progression (between 15 and 18 years).
  • Younger patients show greater initial in-brace correction. Curve correction with bracing that is greater than 50% is expected to have a final net correction, whereas curve correction of less than 50% is expected to have limited progression.
  • Generally, curves between T8-L2 have the best response to correction. Young patients with large curves usually fail treatment with a brace.
  • Patients whose curve initially measures 20-45º and who successfully complete treatment for idiopathic scoliosis using a TLSO can anticipate that their scoliosis will remain stable until adulthood. The correction of the curvature can be lost over time, with the curve returning to its initial magnitude. Therefore, obtaining a spinal radiograph in the third or fourth decade of life to check progression is reasonable.

Milwaukee brace

The Milwaukee Brace is commonly used for high thoracic (mid-back) curves. It extends from the neck to the pelvis and consists of a specially contoured plastic pelvic girdle and a neck ring connected by metal bars in the front and the back of the brace. The metal bars help extend the length of the torso and the neck ring keeps the head centered over the pelvis. Pressure pads, strategically placed according to the patient's curve pattern, are attached to the metal bars with straps.

The Milwaukee Brace was the first modern brace designed for the treatment of scoliosis. Developed by Drs. Walter Blount and Albert Schmidt of the Medical College of Wisconsin and Milwaukee's Children's Hospital in 1945, its design has been tweaked through the years until reaching its current design around 1975. Today, the brace is used less frequently now that more form-fitting plastic braces have been developed; however, it's still prescribed for some types of curves that are located very high in the spine.

http://www.iscoliosis.com/images/MilwaukeeBrace.jpg

The Milwaukee brace is a CTLSO that was originally designed by Blount and Schmidt to help maintain postoperative correction in patients with scoliosis secondary to polio. The brace is designed to stimulate corrective forces in the patient. When the patient has been fitted properly with a brace, the trunk muscles are in constant use; therefore, disuse atrophy does not occur. The brace has an open design, with constant force provided by the plastic pelvic mold. The pelvic portion helps reduce lordosis, derotates the spine, and corrects frontal deformity.

The uprights have localized pads that apply transverse force, which is effective for small curves. The main corrective force is the thoracic pad, which attaches to the 2 posterior uprights and to 1 anterior upright. Discomfort from the thoracic pad creates a righting response to an upright posture. In contrast to the thoracic pads, the lumbar pads play a passive role.

The uprights are perpendicular to the pelvic section, so any leg-length discrepancy should be corrected to level the pelvis. The neck ring is another corrective force and is designed to give longitudinal traction. Jaw deformity is a potential complication of the use of the neck ring. The throat mold, instead of a mandibular mold, allows the use of distractive force without the development of jaw deformity.

As a child grows, the brace length can be adjusted. In addition, pads can be changed to compensate for spinal growth. The brace needs to be changed if pelvic size increases. Average cost of this brace is approximately $2100-$2300.

Indications for the use of a Milwaukee brace include the following:

  • Patients with a Risser score of I-II, as well as a curve that is greater than 20-30° and that progresses by 5° over 1 year
  • Curves of 30-40°, but not curves of less than 20°.

Curves of 20-30°, with no year-over-year progression, require observation every 4-6 months. The Milwaukee brace is used for curves in which the apex is above T7.

The Milwaukee brace's duration of use is determined by the following criteria:

  • Daily use ranges from 16-23 hours per day.
  • Treatment should continue until the patient is at Risser stage IV or V.
  • If the curve is greater than 30°, consider continued use of the brace for 1-2 years after maturity, because a curve of this magnitude is at risk of progression.

Problems that are associated with the use of a Milwaukee brace include the following:

  • Jaw deformity
  • Pain
  • Skin breakdown
  • Unsightly appearance
  • Difficulty with mobility
  • Difficulty with transfers
  • Increased energy expenditure with ambulation

Failure to correct deformity can be caused by any of the following:

  • Poor patient compliance
  • Improper fit
  • Curves below T7

Keep in mind clinical information regarding the use of the Milwaukee brace, including the following:

  • Only 40% of patients with curves of 20-29° progressed with a Milwaukee brace, compared with 68% by natural history without bracing.
  • When comparing the Milwaukee brace with the Boston brace (described below), note that curve progression beyond 45° occurred in 31% of patients with the Boston brace and in 62% with the Milwaukee brace.
  • Radiographs that are used to evaluate scoliosis in the Milwaukee brace should be taken with the patient in a standing position.
  • Successful outcomes with brace treatment show an in-brace curve reduction of greater than 50%.
  • The Milwaukee brace and a custom-made TLSO can be used to treat Scheuermann kyphosis in children with pain or to treat pain associated with kyphosis of greater than 60°.

Boston brace

There are a variety of TLSO braces, but the one most commonly used to treat scoliosis is the "Boston Brace." TLSO braces are often called "low-profile" or "underarm" braces. They are not as large or bulky as the Milwaukee Brace (see below), and their plastic components are custom-molded to fit the patient's body.

The Boston Brace extends from below the breast to the beginning of the pelvic area in the front and from below the shoulder blades to the tail bone in the back. This type of brace works by applying three-point pressure to the curve to prevent its progression. It forces the lumbar area to flex, which pushes in the abdomen and flattens the posterior lumbar curve. Strategically placed pads place pressure on the curve, and "relief voids" are located opposite the areas of pressure.

Developed in the early 1970s by Dr. John Hall and Mr. William Miller of The Boston Children's Hospital, the Boston Brace is typically prescribed for curves in the lumbar (low-back) or thoraco-lumbar (mid- to low-back) sections of the spine.

http://www.iscoliosis.com/images/BostonBrace.jpg


The Boston brace is a prefabricated, symmetric, thoracolumbar-pelvic mold with built-in lumbar flexion, that can be worn under clothes. Lumbar flexion is achieved through posterior flattening of the brace and extension of the mold distally to the buttock. Braces with superstructures have a curve apex above T7. Curves with an apex at or below T7 do not require superstructures to immobilize cervical spine movement. Unlike the Milwaukee brace, the Boston brace cannot be adjusted if the patient grows in height. Both braces need to be changed if pelvic size increases. The average cost of the Boston brace is approximately $2000.

Indications for the use of a Boston brace include the following:

  • A curve of 20-25° with 10° progression over 1 year
  • A curve of 25-30° with 5° progression over 1 year
  • Skeletally immature patients with a curve of 30° or greater

Problems that are associated with the use of a Boston brace include the following:

  • Local discomfort1
  • Hip flexion contracture
  • Trunk weakness
  • Increased abdominal pressure
  • Skin breakdown
  • Accentuation of hypokyphosis in the thoracic spine, above the brace

Certain preventive measures can reduce difficulties that are associated with the use of a Boston brace, including the following:

  • A regimen of hip stretches decreases contractures at the hip.
  • Exercise to promote active correction in the brace is suggested.

The presence of thoracic hypokyphosis is a relative contraindication for the use of a Boston brace.

Failure of the Boston brace to correct deformity can occur because of several factors, including the following:

  • Curve above T7
  • Improper fit
  • Poor patient compliance

The Boston brace's duration of use is determined by several factors, including the following:

  • Daily use ranges from 16-23 hours per day.
  • Treatment should continue until the patient is at Risser stage IV or V.
  • If the curve is greater than 30°, consider continued use for 1-2 years after maturity, because these curves are at risk of progression.
  • The Boston brace is as effective without the superstructure as it is with the superstructure in the treatment of curves in which the apex is below T7.15

Clinical information that is relevant to the use of the Boston brace includes the following:

  • Use of a Boston brace is a more effective means of preventing curve progression and avoiding surgery than is the use of a Charleston bending brace.
  • One study looked at skeletally immature patients with idiopathic scoliosis who were at least age 10 years when a brace was prescribed. In members of this group who had a curve of 36-45º, nearly 43% who used the Boston brace experienced a curve progression of more than 5°, compared with 83% of those using the Charleston bending brace.16
  • The use of a Charleston bending brace is indicated only with lumbar or small thoracolumbar curves; avoid use in thoracic curves.
  • Radiographs used to evaluate scoliosis in the Boston brace are taken with the patient in a standing position.
  • Successful outcomes with brace treatment show an in-brace curve reduction of greater than 50%.

Charleston bending brace

Developed in 1979 by Dr. Frederick Reed and Ralph Hooper, the Charleston Bending Brace is worn only at night, which is why it's also known as a "part-time" brace

The Charleston Bending Brace is molded to conform to the patient's body while he or she is bent towards the convexity—or outward bulge—of the curve, the concept behind this design being that it "over-corrects" the curve during the eight hours the brace is worn.

The Charleston brace is typically recommended for spinal curves of 20-35 degrees, with the apex of the curve below the level of the shoulder blade.

Other braces your doctor may recommend include:

  • The Providence Brace, a computer-fitted brace worn only at night.
  • A bracing method called SpineCor, which uses adjustable bands and a cotton vest that allows flexibility.
  • The Wilmington Brace (TLSO), a total-contact orthosis typically fabricated from a lightweight plastic material called Orthoplast. The brace is designed as a "body jacket," with a front closure and adjustable Velcro straps.

http://www.iscoliosis.com/images/CharlestonBrace.jpg


The Charleston bending brace is a rigid, custom-made orthosis that is designed to improve patient compliance by correcting scoliosis at nighttime.17 This brace holds the patient in maximum side-bending correction. The Charleston bending brace costs approximately $2000.

Indications for the use of this particular brace include the following:

  • A curve of 20-25° with 10° progression over 1 year
  • A curve of 25-30° with 5° progression over 1 year
  • Skeletally immature patients with a curve of 30° or greater

Clinical information regarding the use of the Charleston bending brace includes the following:

  • The Charleston bending brace is significantly less effective than the Boston brace in the treatment of double major curves and single thoracic curves in patients with Risser stage 0-I.
  • Over 50% of patients with a single thoracic curve who were treated with a Charleston bending brace required surgery, compared with 24% of patients who were treated with a Boston brace.
    • As a result, the Charleston bending brace is not recommended for use in thoracic curves.
  • The Charleston bending brace is less effective in the treatment of single thoracolumbar or lumbar curves, but the figures are not statistically significant compared with those for the Boston brace.16
  • Radiographs that are used to evaluate scoliosis with the Charleston bending brace are performed with the patient in a supine position, because the patient wears the brace while sleeping supine.
  • Successful outcomes with brace treatment show an in-brace curve reduction greater than 50%.

 

 

reference: http://www.iscoliosis.com/articles-brace_types.html

 
General Description - Lumbosacral Orthoses PDF Print E-mail

Lumbosacral Orthoses

Chairback brace


The chairback brace, shown below, is a short, rigid lumbosacral orthosis (LSO) with 2 posterior uprights that have thoracic and pelvic bands. The abdominal apron has straps in front for adjustment in order to increase intracavitary pressure. The thoracic band is located 1 inch below the inferior angle of the scapula. The thoracic band extends laterally to the midaxillary line, and the pelvic band extends laterally to the midtrochanteric line. Place the pelvic band as low as possible without interfering with sitting comfort. Position the posterior uprights over the paraspinal muscles. Uprights can be made from metal or plastic. The brace uses a 3-point pressure system and can be custom molded to improve the fit for each patient. The chairback brace costs approximately $440.

Chairback brace (side view).
Chairback brace (side view).

Indications for the use of a chairback brace include the following:

  • Unloading of the intervertebral disks and the transmission of pressure to soft-tissue areas
  • Relief of low back pain (LBP)
  • Immobilization after lumbar laminectomy
  • Kinesthetic reminder to the patient following surgery

Motion restrictions associated with the chairback brace include the following:

  • Limits flexion and extension at the L1-L4 level
  • Minimally limits rotation
  • Limits lateral bending by 45% in the thoracolumbar spine

Chairback Ortho-Mold brace


The chairback Ortho-Mold brace is similar to the chairback brace, but it has a rigid plastic back piece custom-molded to the patient. The plastic back can be inserted into the canvas-and-elastic corset. The chairback Ortho-Mold brace costs approximately $500-$600.

Indications for the use of a chairback Ortho-Mold brace and its motion restrictions are the same as the chairback brace noted above.

Williams brace


The Williams brace is a short LSO with an anterior elastic apron to allow for forward flexion. Lateral uprights attach to the thoracic band, and oblique bars are used to connect the pelvic band to the lateral uprights. The abdominal apron is laced to the lateral uprights. The brace limits extension and lateral trunk movement but allows forward flexion. The Williams brace costs approximately $500.

The brace is indicated for the treatment of spondylolysis and spondylolisthesis, being used to provide motion restriction during extension. The device is contraindicated in spinal compression fractures.

Motion restrictions of the Williams brace include the following:

  • Limits extension
  • Limits side bending at the terminal ends only

MacAusland brace


The MacAusland brace is an LSO that limits only flexion and extension. This brace has 2 posterior uprights but no lateral uprights. The 3 anteriorly directed straps connect with the abdominal apron to provide increased support. The MacAusland brace costs approximately $510.

Indications for the use of a MacAusland brace are similar to those for the chairback brace. (See the indications for the chairback brace.) Motion restrictions include limitation of flexion and extension at the L1-L4 level.

Standard lumbosacral orthotic corset


The standard lumbosacral orthotic corset has metal bars within the cloth material posteriorly that can be removed and adjusted to fit the patient. The anterior abdominal apron has pull-up laces in the back that are used to tighten the orthosis. The abdominal apron can come with a Velcro closure for easy donning and doffing. The corset, which increases intracavitary pressure, has a lightweight design and is comfortable to wear. Anteriorly, the brace covers the area between the xiphoid process and the pubic symphysis. Posteriorly, it covers the area between the lower scapula and the gluteal fold. The average cost of the corset is approximately $150.

Indications for the use of a standard lumbosacral orthotic corset include the following:

  • Treatment of LBP
  • Immobilization after lumbar laminectomy

Motion restrictions associated with the corset include the limitation of flexion and extension.

Rigid LSO


The rigid LSO, shown below, is a custom-made orthosis that is molded over the iliac crest for an improved fit. Plastic anterior and posterior shells overlap for a tight fit. Velcro closure in the front is designed for easy donning and doffing. Multiple holes can be made for aeration to help decrease moisture and limit skin maceration. The rigid LSO can be trimmed easily to make adjustments for patient comfort, and it may be used in the shower if necessary. A rigid LSO costs approximately $500-700.

Custom-molded, plastic lumbosacral orthosis (LSO).
Custom-molded, plastic lumbosacral orthosis(LSO).

Indications for the use of a rigid LSO brace include the following:

  • Postsurgical lumbar immobilization
  • Treatment of lumbar compression fractures

Motion restrictions provided by the rigid LSO brace include the following:

  • Limits flexion and extension
  • Limits some rotation and side bending

Rigid LSO with hip spica


A rigid LSO with hip spica uses a thigh piece on the symptomatic side and extends to 5 cm above the patella. The hip is held in 20° of flexion to allow sitting and walking. After the orthosis is applied, some patients require a cane for ambulation. The average cost of a rigid LSO with hip spica is about $1100.

Indications for immobilization with the rigid LSO with hip spica include the following:

  • Lumbar instability at L3-S1
  • Lumbosacral fusion with anchoring to the sacrum - Postoperative

Motion restrictions associated with the rigid LSO with hip spica include the following:

  • Limits flexion and extension
  • Limits some rotation and side bending

New brace designs for LSOs include strapping systems that pull the brace inward and up, improving the hydrostatic effect in order to relieve pressure on the lumbar spine. The better fit helps limit migration. Some low-profile designs take pressure off the hip and rib area, which, in turn, improves patient compliance. Low-profile braces fit more easily under clothing. These braces can treat areas from L3-S1.

Some spinal braces have an interchangeable back with an open center or a flat back design for postoperative patients. The same brace can be interchanged with a back that has an indentation to fit the lordotic curvature of the lumbar spine for pain management purposes. Braces with interchangeable parts allow an LSO to be converted into a TLSO with a large back support and an attachment for a sternal extension to prevent unwanted flexion. The sternal extension has straps that attach to the LSO.

 

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Article Reference: http://emedicine.medscape.com/article/314921-overview

 
General Description - Thoracolumbar Orthoses PDF Print E-mail

General Description

Thoracolumbar orthoses (TLOs) are used mainly to treat fractures between T10 and L2, because their mobility is not restricted by the ribs, unlike fractures between T2 and T9. Immobilization at T10-L2 helps to prevent further collapse.

CASH brace


The cruciform anterior spinal hyperextension (CASH) brace, shown below, features anterior sternal and pubic pads to produce force opposed by the posterior pad and strap around the thoracolumbar region. Sternal and pelvic pads attach to the anterior, metal, cross-shaped bar, which can be bent to reduce excess pressure on the chest and pelvis. The brace is easy to don and doff, but it is difficult to adjust. It provides greater breast and axillary pressure relief than does the Jewett hyperextension brace (described below). Two round upper chest pads can be used instead of the sternal pad to decrease discomfort around the breast area. The average cost of a CASH brace is approximately $460.

Cruciform anterior spinal hyperextension (CASH) b...
Cruciform anterior spinal hyperextension (CASH) brace with round anterior chest pads.


Indications for the use of a CASH brace include the following:

  • Flexion immobilization to treat thoracic and lumbar vertebral body fractures
  • Reduction of kyphosis in patients with osteoporosis

Motion restrictions provided by the CASH brace include the following:

  • Limits flexion and extension at T6-L1
  • Ineffective in limiting lateral bending and rotation of the upper lumbar spine

Contraindications to the use of a CASH brace include the following:

  • Three-column spinal fractures involving anterior, middle, and posterior spinal structures
  • Compression fractures caused by osteoporosis

Jewett hyperextension brace


The Jewett hyperextension brace, shown below, uses a 3-point pressure system with 1 posterior and 2 anterior pads. The anterior pads place pressure over the sternum and pubic symphysis. The posterior pad places opposing pressure in the midthoracic region. The posterior pad keeps the spine in an extended position, and its lightweight design makes it more comfortable than the CASH brace. Pelvic and sternal pads can be adjusted from the lateral axillary bar, where they attach. The pads can cause discomfort from pressure applied to a small surface area. No abdominal support is provided with this device. When the patient is seated, the sternal pad should be half an inch inferior to the sternal notch, and the pubic pad should be half an inch superior to the pubic symphysis. The Jewett brace costs approximately $460 and is not custom-molded.

Jewett® hyperextension brace. Image courtes...
Jewett® hyperextension brace. Image courtesy of Florida Brace Corporation.

Indications for the use of a Jewett brace include the following:

  • Symptomatic relief of compression fractures not caused by to osteoporosis
  • Immobilization after surgical stabilization of thoracolumbar fractures

Motion restrictions provided by the Jewett brace include the following:

  • Limits flexion and extension between T6-L1
  • Ineffective in limiting lateral bending and rotation of the upper lumbar spine

Contraindications for the use of a Jewett brace include the following:

  • Three-column spinal fractures involving anterior, middle, and posterior spinal structures
  • Compression fractures above T6, because segmental motion increases above the sternal pad
  • Compression fractures caused by osteoporosis

One important consideration in the use of the Jewett brace is that it is more effective than the CASH brace. The Korsain brace is a modification of the Jewett brace, with added abdominal support for increased rigidity. The cost of the Korsain brace is similar to that of the Jewett brace.

Indications for the Korsain brace include the following:

  • Symptomatic relief of compression fractures not caused by osteoporosis
  • Immobilization after surgical stabilization of thoracolumbar fractures
  • Flexion immobilization to treat thoracic and lumbar vertebral body fractures

Motion restrictions and contraindications associated with the Korsain brace are similar to those of the Jewett brace.

Knight-Taylor brace


The Knight-Taylor brace features a corset-type front with lateral and posterior uprights and shoulder straps to help reduce lateral bending, flexion, and extension. The shoulder straps may cause discomfort in some patients. The brace can be prefabricated and made with polyvinyl chloride or aluminum. The posterior portion of the brace has added cross supports below the inferior angle of the scapula and features a pelvic band fitted at the sacrococcygeal junction. The anterior corset is made of canvas and provides intracavitary pressure. The anterior corset is laced to the lateral uprights. The average cost of the Knight-Taylor brace is approximately $540.

Use of the brace is indicated when flexion immobilization is required to treat thoracic and lumbar vertebral body fractures.

Motion restrictions associated with the Knight-Taylor brace include the following:

  • Limits flexion, extension, and lateral bending
  • Poor rotation control

Thoracolumbosacral orthosis


A custom-molded plastic body jacket, or thoracolumbosacral orthosis (TLSO), is fabricated from polypropylene or plastic. It offers the best control in all planes of motion and increases intracavitary pressure. This orthosis has a lightweight design and is easy to don and doff. The material is easy to clean and comfortable to wear. This brace sometimes is referred to as the clamshell.7

The TLSO provides efficient force transmission, with pressure distributed over a wide surface area; it is therefore ideal for use in patients with neurologic injuries. The brace may have a tendency to ride up on the patient when he/she is in a supine position. Plastic retains heat, but an undershirt will help to absorb perspiration and protect the skin. Frequent checks to ensure proper fit will aid in preventing pressure ulcers. Velcro straps are used to tighten the brace. The average cost of a TLSO made with polyform material is $1250-$1700.

Indications for the TLSO include the following:

  • Immobilization for compression fractures from osteoporosis
  • Immobilization after surgical stabilization for spinal fractures
  • Bracing for idiopathic scoliosis
  • Immobilization for unstable spinal disorders at T3-L3

Motion restrictions for the TLSO include the following:

  • Limits sidebending
  • Limits flexion and extension
  • Limits rotation to some extent

Clinical information on the custom-molded TLSO suggests that it is more effective in the prevention of idiopathic scoliosis curve progression than are the Milwaukee brace and the Charleston bending brace (described below). A retrospective cohort study found that the mean curve progression with a TLSO was less than 2°, while curve progression with the Charleston and Milwaukee braces was greater than 6°.8 According to the report, fewer than 18% of patients treated with a TLSO brace required surgery for scoliosis, compared with 23% of patients treated with a Milwaukee brace and 31% of patients treated with a Charleston brace.

 

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Original Article Reference: http://emedicine.medscape.com/article/314921-overview

 
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