Purpose of Braces in Spine Surgery
Your spine surgeon may have discussed performing surgery on your neck or back. While recovering from surgery you will wear a brace, which is a type of orthotic (a mechanical appliance for orthopaedic use). The brace helps to hold everything immobile while you are healing. This is an important part of a successful outcome and your physician's instructions need to be followed precisely. The following is a description of the various braces used in spine surgery.
The cervical (neck) orthoses most commonly used:
Soft Cervical Collar: A flexible, usually white, collar which is used mostly as a transition between the more rigid collars and no collar at all. It can be removed for bathing and shaving per your doctor's instructions.
Philadelphia Collar: A more rigid collar (beige in color) consisting of two pieces, front and back, attached on the sides by Velcro. This collar is typically worn following a cervical fusion, cervical strain or after certain types of fractures that are not considered highly unstable. It is usually worn 24 hours a day and can only be removed per your physician's instructions. Patients are more comfortable if cornstarch and/or a silk scarf is applied next to the skin, underneath the collar.
Miami J Collar: Similar in function to a Philadelphia Collar, it is made of white plastic and blue Gortex material.
Halo: Allows for the most rigid fixation of the cervical spine and is only used for multiple-level complex cervical spine surgery or if a patient has an unstable fracture. It consists of a titanium ring (or halo) around the patient's head which is held in place by four screws (or pins) in the skull. The ring is attached by four bars to a vest worn on the trunk to anchor the device and hold the neck in place. This device is worn at all times until the spine heals. Patients actually find chewing and talking less awkward with this device because it does not restrict chin movement.
SOMI Brace and Minerva Brace: Used less often, but may be chosen by your surgeon as an alternative.
Thoracic and Lumbar Spine
The orthoses most commonly used for the mid and low back:
Clamshell Brace, TLSO (Thoracic Lumbar Sacral Orthosis) or LSO (Lumbar Sacral Orthosis): These are all different names for the same type of brace. These devices may be worn for several months following a fusion of the thoracic and/or lumbar spine until the fusion appears solid on X-ray. It consists of two pieces of rigid plastic and may extend from the armpits to the groin, depending on your physician's specifications. This brace will be custom made for you. You will usually be measured for this by an Orthotist before surgery. It can typically be removed for bathing only while lying flat in bed, according to your physician's instructions.
Knight-Taylor Brace: Also worn after a fusion, sometimes after the Clamshell Brace. It consists of metal and canvas with buckles in the front. It also extends from the armpit to the groin and is custom made.
Specific instructions regarding use of any of these braces (such as sleeping in or out of the brace) must come from your doctor. And remember, don't be afraid to ask questions!
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