Spinal Bracing can Provides Pain Relief in Patients Awaiting Elective Surgery

When determining whether a patient may benefit from a spinal orthosis, it is important to understand the three main treatment categories:

1. Pain

Pain in the neck, thorax, or low back can be reduced by the use of an appropriate orthosis. Most clinicians recognize that pain relief with orthoses works by reminding the patient to avoid extreme, abrupt, stressful movements, and promote rest for affected anatomic structures. Orthoses may also limit the range in which the patient can move and foster a more satisfactory vertebral alignment. These functions can lessen pain by minimizing faulty muscle action.

2. Trauma and Post-Op Care

The use of orthoses following surgery or spinal trauma varies considerably depending on the type of surgery, the particular injury that has occurred, and whether or not surgical stabilization has been performed.

Orthoses serve several purposes in the treatment of spinal trauma and can be used as a solution for either short-term or longer-term treatment plans. The external support of the orthosis can help to reduce pain as well as provide some added stability while fractures and soft tissue injuries heal. In addition, orthoses can help to prevent deformity during the healing phase of the injury, reduce spinal tension and reduce the motions such as twisting or spinal flexion that delay healing, as well as increase overall stability of the spine.

In 2014, a re-published case study by Wood et al. described a prospective, randomized study comparing operative to non-operative treatment for thoracolumbar burst fractures.¹ The study enrolled 53 patients–26 patients were randomized to the operative arm and 27 patients to the non-operative arm. Follow up occurred for up to 2 years, and the results showed the non-operative patients using a custom thoracolumbosacral orthosis placed in hyperextension for 8-12 weeks were found to have no differences in radiographic findings between the operative and non-operative treatment arms. These findings suggest that treatment with a spinal orthosis may be beneficial for patients who are in need of surgery but cannot schedule a procedure due to the COVID-19 pandemic.

3. Deformity

The use of spinal orthoses for the treatment of spinal deformities is ever-evolving. The treatment of spinal deformities with an orthosis most commonly involves adolescent idiopathic scoliosis, congenital neuromuscular scoliosis, and Scheuermann’s disease. In the adult population, most spinal deformities are the result of degenerative changes over time resulting in postural changes, decreased activities, and pain. Recently, evolutions in orthosis treatments are showing promise in the management of the adult spinal deformities and pain.

Researchers at the University of Michigan’s (U-M) Robotics Institute have developed a prototype for a new kind of robotic prosthetic leg. It has smaller but more powerful motors that encourage a more natural gait when worn.

With the improved motors—initially designed for a robotic arm on the International Space Station—this prototype is more efficient and quieter than other robotic leg designs.

Peripheral Nerve Stimulation (PNS) is known to relieve chronic pain by sending electrical impulses to the affected nerves. While the technology is not touted as a treatment for phantom limb pain, the connection is evident. To further explore this connection, two major initiatives are underway to test the potential of PNS for relieving phantom limb pain, and the early results are pretty hopeful.

A preliminary report shows that 75% of the subjects treated with the Sprint PNS system experienced substantially less pain than the control group during the first eight weeks after amputation. According to the lead investigator on the study, Denise Lester M.D., the first eight weeks is a critical time to control or minimize phantom limb pain.

Generally, people with high post-operative pain are at greater risk of developing persistent pain. Implementing PNS immediately after amputation may help short-circuit the establishment of pain-causing neural pathways. This is because PNS operates almost like a pacemaker—it threads tiny electrodes under the skin and pulses rhythmically, which drowns out erratic neurological signals.

In effect, PNS retrains the nerves before they develop patterns associated with phantom limb pain. Furthermore, Lester says that the immediate implementation of PNS can prepare patients to be fitted for a prosthesis as early as two months after amputation.