The answer to the first of my questions to my orthotist
confirmed what I had already suspected - that I was wearing the only one of my
rigid neck braces that I could combine with the back brace I was also wearing
at the time. Further, neither of us was aware of another type of neck brace
that would be as effective under the circumstances in which I now found myself.
My neck brace was the moulded thermoplastic 'doll's collar' which had seen such
sterling service over the years. Of those I have worn, from time to time when
necessary, this is still the one that I much prefer to wear, at least in
public, when my cervical syndrome is acute. It offers the best trade-off
between the firm support I require at such times, comfort and cosmetic
appearance. I can disguise it beneath a skivvy or turtle-neck sweater, and it
lacks the unsightly metal struts characteristic of my SOMI and other such rigid
cervical orthoses.
For details of how I had come to acquire a variety of such equipment over the
years, all of it effective in its respective ways, you may wish to refer to
previous accounts of my experiences. These relate my having been put in, and
subsequently liberated from, a full spinal brace (CTLSO), following spinal
injuries sustained in an aircraft accident many years ago, and my experiences
in the management of my back and neck problems since (Spinal Fracture and If
the Brace Fits, Wear It!).
My orthotist had made the doll's collar for me originally and seemed surprised
that it had stood the test of time, despite my only having worn it for a small
proportion of that time. I complimented him on his having provided me with an
appliance that has served me so well and for so long whenever I have depended
upon it.
If you have read the above accounts, you may be aware that I have had
relatively few problems with my back, as apart from my neck, over the years. An
occasional spell in traction has settled down the pain I sometimes get from
disc lesions adjacent to the (lower thoracic) fracture site. In recent times,
however, I had found that wearing another back brace been had been useful as
well, keeping my lower- thoracic and lumbar spine in extension and preventing
the sciatic pain that flexion can engender at such times.
A brief word about it may be of interest. It is a 'Jewett' hyperextension
brace, named for its designer - an orthopaedic surgeon of the 1930s. Unlike the
Taylor-type brace which had comprised the lower part of my original CTLSO, with
its dorsal frame, it consists of a pad over the sternum, an anterior
half-pelvic band and a dorsal pad in the lower thoracic/upper lumbar region,
all connected to a laterally-padded anterior aluminium alloy frame. It is a
fairly comfortable thing to wear, not restricting the shoulder girdle.
It is also very easy to don and doff. The webbing strap holding the dorsal pad
attaches with a single fastener on one side - a 'dot' fastener with which you
will be familiar if you have owned a sports car with a tonneau cover - and a
tensioning lever on the other. You can get into or out of it in seconds!
When my back syndrome is acute, simply preventing flexion is usually sufficient
to keep my symptoms (largely the sciatic pain) at bay. Thus, the hyperextension
brace is ideal, controlling flexion but allowing some movement of the upper
thoracic spine where it doesn't matter. (The product, and medical, literature
on these braces does not claim control of the spine above about T7, and, as my
original lesion was at the T10 level, this upper-thoracic movement comes with
no clinical disadvantage.)
This is in marked contrast to my neck, however, where the most effective
treatment is maximal immobilisation of the mid-cervical spine in all planes,
and taking (non- steroidal) anti-inflammatories until the symptoms, typically
pain and paraesthesia due to nerve root pressure, settle down.
There are times when I need to wear my back brace, and others when I wear one
of my neck braces. When I (fortunately rarely) experience a return of both my
cervical and lower-back problems, I find that I can wear the back brace with my
doll's collar, as the sternal pad of the former rides easily over the collar's
close-fitting plastic shell. This is not possible with my SOMI or Minerva
braces though - nor, I supposed, with any other cervical brace which extends to
the thorax - as my orthotist had just confirmed.
This scenario is not a problem as long as the weather does not get too hot. As
I have indicated elsewhere, it's hot weather that makes the total-contact
doll's collar very uncomfortable and my SOMI preferable, despite its
less-than-attractive appearance.
As to having to wear both braces in hot weather, the inevitable had to happen
(said he tautologically!). I was offered a secondment with a division of my
organisation in the tropics at a time when I needed to wear both!
I had flown up to our office there, for a couple of days, to discuss the
possible transfer with colleagues, and this experience had reaffirmed that my
doll's collar was simply not an option in the hot and humid tropical
conditions. My original CTLSO, made for me at the time of sustaining my
injuries initially, may have been, but it had long since been discarded.
Which brings me back to the appointment with my orthotist and
my second question to him. Was there a ready solution to my problem without
having to have another such appliance custom-made for me? Well, it appeared
that there might be. Together, we examined a catalogue of various spinal
orthoses manufactured by a supplier in Florida. Depicted was a variety of
Jewett-type hyperextension braces, two-poster cervical braces and, as you may
have guessed from the title of this article, combinations of the two.
The cervical braces looked familiar. I remember having tried on a similar one
several years ago before electing to wear a SOMI instead. These two-posters
comprised occipital and mandibular pads attached to a yoke over the shoulders
and a sternal pad respectively, these two joined, and with struts extending
anteriorly and posteriorly to lower-thoracic pads joined by webbing straps
around the torso. I had thought at the time that such a device was too
restricting and had settled for the SOMI instead - a touch ironic in the
current circumstances!
I have mentioned cervical braces plural, and the variants illustrated were of
interest. The brace that I recalled had had webbing straps connecting the yoke
to the sternal pad and leather ones connecting the mandibular and occipital
pads, with snap fasteners at the mandibular ends - much the same as with my
SOMI. With these, though, alternative connectors were offered in the form of
rigid aluminium bars which replaced the straps.
The spinal braces looked similar to the one I was wearing but with some
differences - of which more later. As I have mentioned, there was also an
illustration of a device which combined a hyperextension brace with a cervical
one as described above, but with the anterior strut attaching to the top of the
frame of the back brace, instead of to sternal and abdominal pads. The
remainder of the cervical component, with its yolk, occipital and posterior
thoracic pads connected by a strut were largely as I remembered.
My orthotist checked and confirmed the availability of such a prefabricated
CTLSO. We then considered the straps vs rigid-bar options available with it and
settled for the latter - given that the greater the immobilisation of my
cervical spine when acute, the better. He also observed that rigid connectors
between the occipital and mandibular pads would avoid the pressure of the
latter against the front of the neck, an uncomfortable outcome which can occur
when these sorts of braces are set up as firmly as would be necessary in my
case.
Having decided on the specifications for what was to be my new replacement for
them, I removed my neck and back braces and he took appropriate measurements
(chest and waist circumferences, distances between anatomical landmarks etc.).
As I donned them again, we both noted the small amount of relative movement
between my neck and back braces, an advantage of which I was already aware.
Wearing separate ones means that I have that little bit of flexion and rotation
at the upper thoracic/lower cervical level, where it doesn't matter clinically
for me, and am able to look down, and from side to side, to a limited degree
without bending at the hips or rotating my whole body.
It was brought home to me that these small relative movements are nice to have
and that I was probably going to lose them. I would also, of course, lose in
appearance, replacing my reasonably cosmetic collar with an orthosis which
would again have my neck supported by the sorts of metal struts that I find,
even after so many years, to be a real turn-off aesthetically, especially in
public, making you look as if you have been swallowed by a radar antenna!
As I left, I contemplated what was in store for me, and how significant the
loss of that small amount of movement might prove.
To Be Continued.
The above story is more great work from the author of "Spinal
Fracture" & "If The Brace Fits, Wear It" Again this
story was based on true facts --- Our thanks to the anonymous author for a
another great job -- we look forward to more stories in the future!
Sincerely,
Binkly
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