The day for the fitting of my new cuirass came soon enough and I arrived at
the orthotist's with a little trepidation, despite my long association with a
variety of spinal orthoses. Illustrations are all very well, but when you first
actually wear a new brace, especially one as restrictive as this one would be,
you can get a surprise or two and have to be prepared for a period of
adjustment to your new equipment - however beneficial it might be for you in
the long run.
I again removed my back brace and collar and my orthotist helped me into,my new
rig. The new back brace component was similar, but with some differences.
Whereas the one I had been wearing has a half-pelvic band at the front, the new
one had the anterior frame curving inwards above, and downward between, the
anterior superior iliac crests (hip bones), terminating at a pad over the pubic
symphysis. I would discover that this was an important difference.
The method of attachment and adjustment of the posterior pad differed too.
Instead of the convenient 'dot' fastener on, one side and tensioning lever on
the other, this had (two) straps fixed on the left side, passing through loops
on the pad and terminating in a worm-drive mechanism. This was in turn
positioned behind a hook attached the frame on the right hand side, so shaped
that, when the mechanism was wound up, it could not be detached without
unwinding it. Donning and doffing were not going to be achieved nearly so
rapidly, and certainly not 'in seconds', but the attachment was very secure and
to a small extent adjustable.
The other difference was, of course, the mandibular pad which cupped my chin,
attached by its short single strut to the top of the brace's frame.
Next came the remainder of the cervical extension. Its yolk was placed over my
shoulders and the aluminium bars connecting it to the frame positioned over
threaded posts and secured with knurled nuts. Similarly-attached bars coupled
the mandibular and occipital pads. Finally, webbing straps attaching the
additional posterior pad to the frame were tensioned and the assembly of my new
CTLSO was complete.
I walked around in it and then sat down. I then realised the importance of the
pubic pad vis-a-vis the pelvic band. With the latter, your upper thighs
press against the band and displace the sternal pad of the brace superiorly a
little. This movement does not matter with the back brace alone, but would have
been a real problem had that movement been transferred to the cervical
extension.
'I know what it's like to have to wear one of these things,' I said as I
explored the minimal amount of movement possible in my new appliance, 'but what
reactions do you get from people who are put in them for the first time?' My
orthotist replied that they could be fairly dramatic, with some patients being
quite apprehensive about their new-found restriction and appearance.
I also enquired as to the sorts of conditions for which CTLSOs were prescribed
(as well as for patients such as myself who need stabilisation of the spine at
more than one level. He cited high-thoracic fractures and conditions involving
a general deterioration of the intervertebral joints.
'It's fairly seldom that I am called upon to fit one though.' he observed.
'Most people are prescribed a neck brace, perhaps a Philadelphia collar, or a
SOMI or Minerva like yours for more serious conditions, or a back brace alone.
When I do fit a full spinal brace, it's usually a moulded jacket with a SOMI or
Minerva extension attached.' 'That's not something I'd want to wear where I am
going!' I observed, and he agreed. 'It think that this is a very good solution
for your situation. I certainly can't think of a better one.'
With both of us satisfied with the initial fit of my new brace, I went out to
the waiting cab. You can forget about driving in these sorts of rigs. You can't
look to the side, nor even ahead unless sitting bolt upright. Any leaning back,
even with a slightly flexed neck, gives you an excellent view of the car's head
lining!
If there is a real social disadvantage to wearing a CTLSO - apart from the
appearance of the metal struts - it is, for me, not being able to drive or fly,
at least without another (safety) pilot. (You may recall that I am a glider
pilot and I also fly light aeroplanes.) With a separate neck brace, you can
loosen it or take it off (or detach the chin piece of a SOMI), being careful
with your neck movements of course. But in a full CTLSO, it's all or nothing -
you can't readily take the whole thing off or remove the cervical bit!
Day-to-day activities are to some extent curtailed also. Working at a desk, a
stand to hold reading materials helps of course, as does a repositioned
computer keyboard. Going to the bathroom, at least at home, can also be
challenging, and being seated for all performances can be a very sensible idea
for males as well!
During my period of readjustment to a brace that immobilises the entire spine,
not having had to wear one for many years, it was again brought home to me what
a serious piece of equipment a CTLSO really is. Wearing a neck brace or a TLSO,
and especially the two together, is restricting enough (on your activities, not
just your. movement) but a full spinal brace is something else again. It is not
surprising to read in the medical literature of poor patient compliance with
such devices. Were it not for necessity, and perhaps being prepared by earlier
experiences, I may well have had real misgivings about pursuing this course
myself.
Certainly, the wearing of such a piece of equipment as this is not a decision
to be undertaken lightly (assuming that you have any choice in the matter -
something which, initially, I did not). Even for one with my first-hand
knowledge of wearing such spinal orthoses, the experience, at least initially,
can be an interesting one!
--------------------------------------------------------
I spent a day or two in my new rig full-time during the day (and wearing my
relatively comfortable Minerva or SOMI at night, as usual when my neck is
acute), getting used to the increased restriction that it imposed and to
identify any pressure points or other problems (and, frankly, to get used to
appearing in public in such a rig again).
There were very few physical problems - a tribute to the excellent initial fit
of the appliance. Adjustments to achieve the best compromise in flexion, by
varying the length of the anterior strut and the rigid connectors (a new
experience) were all that were necessary when I returned to the orthotist.
These latter were also trimmed to length. I then, gratefully, went back to the
relative freedom of my old back brace and doll's collar until my interstate
move.
To jump forward, and to make this rather long account a little shorter, after
two or three months in the lovely tropical coastal city to which I had been
posted, wearing the CTLSO became less of a necessity and I weaned myself from
it, wearing others of my braces as necessary during the readjustment. This
process has to be gradual, as you are left'with muscle weakness and
previously-denied exercise becomes a necessity, as does regaining range of
movement. Gratefully, I finally returned to a brace-free life again, at least
for the time being.
Since then, my flair-ups have been relatively minor, have not involved my back
and neck together, and the need for a return to total spinal immobilisation has
not since arisen. Touch wood!
--------------------------------------------------------
You, the reader, may ask why I continue to tolerate the restriction and
inconvenience that the orthotic management of my spinal problems imposes,
especially in an appliance as serious as a CTLSO. The answer is fairly simple
however, at least for me. In these accounts, you read only of the times when I
am acute, and that is, happily, a small proportion of the time - a total of a
few months over a number of years. Most of the time, I am pain- (and spinal
brace-) free.
Further, when acute, I am much less dependent on analgesic and other drugs than
I would otherwise be and my recovery is relatively rapid - usually within
months - and, paradoxical as it may seem, my braces actually contribute to my
mobility and productivity at such times. I can be at work in a brace instead of
being home in bed, or drug dependent for normal functioning.
If my syndrome (s) were chronic, and I had to wear such equipment for
significantly greater amounts of time (or all of it), I might well consider a
spinal fusion or fusions. But I work on the principle that I would rather be
inconvenienced for relatively short periods than to have some degree of pain or
disability all of the time - not to mention the permanent loss of movement that
a fusion must inevitably entail.
Further, even though the probability of an adverse surgical outcome might be
small, the effects of one may not be reversible. And I have read, and heard
first-hand, of too many accounts of failed procedures to contemplate the
possibility.
Happily, both my medical advisers and my darling wife agree with my decisions
in these matters and support me through my acute phases in their own ways. And
the amount of sick leave I have had to take due to spinal problems is, over the
years, minimal (leaving aside my initial hospitalisation).
Having said that however, I can understand how some people could not handle
wearing the gear that I have worn and continue to wear when necessary, and have
chosen, or have been encouraged into, surgical or pharmacological solutions
when perhaps a non-invasive orthotic approach may have been a more desirable
alternative.
--------------------------------------------------------
I trust that you have found this account of my experiences of being fitted
with, and living with, another fairly serious spinal brace to be of interest.
I sometimes wonder whether some such narrative as this should be desirable
reading for professionals who prescribe and fit these things - if for no other
reason that they might well gain insights into the physical, and indeed
psychological, implications that the prescription of such orthotic devices has
for their patients, despite the obvious benefits.
Perhaps, as part of their training, they could be encouraged (or even
required?) to spend a week or two full-time in a CTLSO, perhaps a pair of leg
braces, or even both in turn. It's an interesting thought.
Anyway, enough of my editorialising. For myself, it seems that I shall,
probably, have to wear one or more of these arcane orthopaedic appliances, from
time to time at least, for the foreseeable future. I hope though that the
necessity of having to wear my most recently acquired CTLSO does not occur too
frequently. Nevertheless, it sits there, propped up in a comer of our
walk-through wardrobe, reminding me of its availability to keep me well
supported and relatively pain-free when and if the need to wear it again should
arise.
As I said though, I hope that such a necessity will not arise too soon.
Everyday life is so much more convenient without it!
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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