A vertebral compression fracture (VCF) occurs when one of the bony blocks in the spine, called a vertebra, collapses under pressure, typically in the front section of the bone. This collapse leads to a wedge-shaped deformity, which can cause significant pain and a change in spinal alignment. Managing this type of fracture often involves a conservative, non-surgical approach focused on pain reduction and promoting bone healing. A spinal brace, also known as an orthosis, is frequently prescribed as part of this conservative management plan to stabilize the area of injury. The specific type of brace selected is highly dependent on the characteristics of the injury and the patient’s overall condition.
The Mechanical Goals of Spinal Bracing
The primary function of a spinal orthosis for a VCF is to provide external stabilization, similar to a cast on a broken limb. This stabilization limits movement at the fracture site, which reduces pain and prevents micromotion—the subtle shifting of bone fragments that can interfere with natural healing processes.
The most important biomechanical goal is restricting trunk flexion (forward bending), as compression fractures are typically flexion-compression injuries. Preventing forward bending unloads the anterior column of the spine, the damaged part of the vertebra. This mechanism reduces compressive forces acting on the fracture, allowing the bone to heal in a stable position. Some rigid braces also maintain hyperextension, actively counteracting the forward collapse.
Specific Types of Braces for Compression Fractures
Braces used for VCFs are rigid external supports designed to apply pressure strategically to the torso. These devices are categorized by the regions of the spine they cover: thoracic (T), lumbar (L), and sacral (S). Soft, flexible braces or elastic binders are not sufficient for providing the motion restriction required for fracture stabilization.
One of the most common options is the Thoracic Lumbar Sacral Orthosis (TLSO), which is a rigid jacket extending from the upper chest down to the pelvis. A TLSO provides maximum support and motion control by restricting movement in multiple planes, including flexion, extension, and rotation. It is often custom-molded or custom-fitted to the patient’s torso to ensure total contact and optimal pressure distribution.
Two other frequently used braces are the Jewett and the Cruciform Anterior Spinal Hyperextension (CASH) orthoses. These braces utilize a three-point pressure system to actively promote spinal hyperextension (slight backward bending), which is beneficial for anterior column compression fractures. The Jewett typically consists of a frame with pads placed at the sternum, the lower abdomen, and across the back, while the CASH brace uses an anterior cross design to achieve the same mechanical goal.
For fractures located primarily in the lower back, a Lumbar Sacral Orthosis (LSO) may be prescribed instead of a full TLSO. An LSO extends from the bottom of the rib cage to the pelvis and is used when the injury site does not require stabilization of the thoracic spine. While it limits flexion and extension in the lower spine, it provides less overall restriction compared to a TLSO.
Clinical Factors Determining Brace Selection
The decision to use a specific spinal orthosis is based on a thorough evaluation of the injury and the patient’s medical profile. The most influential factor is the location of the fracture, as a higher fracture in the thoracic spine requires a brace that extends higher, such as a TLSO. Conversely, a fracture isolated to the lower lumbar spine may only require the less restrictive LSO.
The stability of the fracture is another primary consideration, determined by the degree of vertebral height loss and involvement of the middle or posterior spinal columns. More severe, unstable fractures that risk worsening deformity require the greater immobilization provided by a total-contact TLSO. The underlying cause of the fracture, such as osteoporosis, high-energy trauma, or a tumor, also influences the treatment plan.
A physician also considers the patient’s age and comfort, as elderly patients with fragile skin or pre-existing conditions may tolerate rigid bracing poorly. Patient compliance is also a factor, since an uncomfortable brace may not be worn consistently, negating its therapeutic effect. The physician determines the most appropriate device by balancing the need for maximum mechanical support with the patient’s ability to wear and manage the orthosis.
Living with the Brace: Management and Care
Once the brace has been custom-fitted by an orthotist, patients receive specific instructions regarding the duration and circumstances of wear. The typical duration is eight to twelve weeks, allowing sufficient time for initial bone healing and acute pain to subside. For most VCFs, the brace is worn while sitting, standing, or walking, and is usually removed only for hygiene and sleeping, though specific instructions can vary.
Maintaining proper skin integrity underneath the brace is necessary to prevent pressure sores or skin breakdown. Patients must wear a clean, well-fitting, seamless cotton t-shirt beneath the orthosis to wick away moisture and provide a protective layer. The skin should be checked several times a day for redness or irritation, especially over bony prominences.
Activity restrictions are in place while wearing the brace; patients are advised to avoid strenuous activity, lifting heavy objects, or twisting motions. Follow-up appointments monitor progress, assess pain levels, and ensure the brace continues to fit correctly as swelling subsides. The brace is discontinued when pain has resolved and radiographic evidence shows adequate bone healing.