Long before cement was being injected into fractured spinal bone; spinal fractures were successfully stabilized using external braces. The principles for non-operative and non-invasive management of spinal fractures can still be applied today at a fraction of the cost of a kyphoplasty. With good pain control, appropriate activity modification, and temporary spinal bracing, unnecessary risks and costs can be avoided. As today’s healthcare costs soar, it is time to take a second look at a proven method for treating compression fractures of the spine.
The braces that can be used in for mild to moderate fractures of the spine are called Throacolumosacral Orthoses (TLSO). Spanning from the sacrum to the shoulders, these devices stabilize the thoracic and lumbar spine. TLSO’s are utilized for minimizing scoliosis during growth periods, post-surgical immobilization, and fracture support. When specifically targeting a vertebral body fracture, the TLSO must provide flexion control. By preventing the spine from flexing forward, the pressure on the anterior column of the spine can be minimized during the healing period.
Three specific braces are considered flexion-control devices: the Taylor brace, the Jewett brace, and the CASH brace. With non-operative care for fractures using one of these three types of TLSO’s, many goals can be accomplished such as: pain control, protection during early ambulation, and stability to the fracture site. Choosing between the three types of braces is a matter of understanding the subtle differences. The Taylor is a good choice for the elderly because it provides both flexion and extension control. The Jewett is more comfortable and more appropriate for younger individuals who do not have a great deal of arthritis in the spine. The CASH brace is very similar to the Jewett, but provides even greater comfort and ease for donning. All of these spinal braces are best supplied by a local orthotic specialist who can fit the brace properly.
Once a brace is prescribed by a doctor and fit by an orthotist, an individual may have to wear it consistently for at least six weeks. Just like a cast, a spinal brace gives the bones a little extra support while they heal into solid bone again. With the extra stability, even an individual with a traumatic “burst” fracture of the spine can experience improved pain control and ambulation. Spinal bracing has been successfully improving quality of life after a spinal fracture for years.
If life does not improve, then the more costly, more risky treatment options should be explored. Unfortunately, many individuals are wheeled into the kyphoplasty or vertebroplasty chamber before a spinal brace is even tired. Why? No one makes very much money on spinal braces. And no one really wants to wear a brace. So, spinal bracing is becoming a forgotten tool collecting dust in the archives of medicine. Maybe this tool should come out of the closet and back into mainstream treatment pathways for spinal fractures.