Vertebral compression fractures (VCFs) occur when a bone in the spine, called a vertebra, collapses, often due to underlying conditions like osteoporosis or significant trauma. This collapse typically happens in the thoracic (mid-back) or lumbar (lower back) regions of the spine, causing a wedge-shaped deformity. For many stable fractures, particularly those without neurological compromise, a spinal brace, or orthosis, is a common non-surgical approach to promote healing and manage symptoms. The specific type of brace prescribed depends heavily on the location and severity of the fracture.
The Functional Goals of Spinal Bracing
The primary objective of fitting a patient with a spinal brace is to stabilize the injured area of the spine. By restricting movement, the brace limits micro-motion at the fracture site, allowing the fractured bone to heal effectively. This immobilization focuses on limiting forward bending, or flexion, which places the greatest compressive stress on the already damaged anterior portion of the vertebra.
A major goal is the reduction of pain, which is often severe immediately following a VCF. A rigid brace provides external support, mechanically unloading the compromised vertebra and thereby diminishing pain signals. This pain relief allows the patient to mobilize sooner, preventing complications associated with prolonged bed rest.
Bracing also serves to maintain correct spinal alignment and prevent the fracture from worsening. VCFs can lead to an exaggerated forward curvature of the spine, known as kyphosis, sometimes referred to as a “dowager’s hump.” By holding the spine in a straighter or slightly hyperextended position, the brace prevents further collapse and the development of this progressive deformity.
Specific Braces Used for Vertebral Compression Fractures
The choice of brace is highly specific to the fracture pattern and the individual patient’s needs. The two most common categories are hyperextension braces and the more comprehensive Thoracic-Lumbar-Sacral Orthoses (TLSO). These devices restrict spinal motion in different ways, offering varying degrees of stability to the fractured segment.
Hyperextension braces, such as the Jewett or CASH (Cruciform Anterior Spinal Hyperextension) orthoses, are frequently used for stable fractures in the lower thoracic and lumbar spine. These braces use a three-point pressure system, applying force to the sternum (breastbone), the pubic area, and the mid-back. This mechanism prevents the spine from bending forward into flexion, encouraging slight hyperextension that relieves pressure on the fractured vertebral body.
A TLSO provides a greater level of immobilization and is typically reserved for more severe, unstable, or higher-level fractures. The TLSO is a rigid, custom-molded or custom-fitted device that encases the torso from the chest down to the hips, often described as a clamshell. This brace limits movement in multiple directions—flexion, extension, and rotation—by providing circumferential compression and total contact with the trunk.
The TLSO offers superior control over the spinal segments compared to hyperextension braces due to its larger coverage and rigidity. Both types support the spine while the bone heals, with the specific prescription guided by the treating physician’s assessment of the fracture’s stability and location.
Living With and Managing a Spinal Brace
Successful treatment with a spinal brace depends on the patient’s consistent adherence to the wearing schedule prescribed by their physician. For acute fractures, the brace may be required to be worn constantly, often up to 24 hours a day, for a period typically lasting between six and twelve weeks. The doctor specifies when the brace can be removed, which may include exceptions for bathing or sleeping, though it is often worn during sleep initially.
Proper fitting is paramount and must be performed by a trained orthotist or healthcare professional to ensure pressure points are correctly positioned for maximal stability and minimal skin irritation. A cotton undershirt or seamless garment should always be worn beneath the brace to wick away moisture and protect the skin from direct contact with the rigid plastic. The skin under the brace must be checked daily for any signs of redness, chafing, or pressure sores, especially around bony prominences.
As the fracture heals, the patient begins a gradual process of weaning off the brace, usually after a follow-up X-ray confirms sufficient bone healing. Long-term use of a rigid brace can contribute to atrophy of the back muscles. Therefore, physical therapy is often initiated during or immediately after the bracing period to regain muscle strength and flexibility that may have been lost during the period of enforced immobilization.