Flat Back Syndrome

[Scoliosis_Gal]

I read this article the other day because i was interested in the new spinecor brace. I have so many questions for my doctor, but i really want to know why I was never told about the side-effects of wearing a plastic brace. In that article it said:
"Unfortunatley the constraints of a hard brace causes a secondary growth deformity known as flat back syndrome. The reduced muscle activity and restriction of movement also contributes cortical depression, which may result in clinical depression as well as decreased awareness of body position and muscle control."
I researched flat back syndrome and it does NOT sound like something that i want to have. I also dont want any of that other stuff to happen to me. I just dont get why my doctor never mi mentioned anything like this to me. Maybe he didnt think that the risk of getting flat back was very high, but it still bugs me that i wasnt told. Anyone else have that problem?
BTW i finally found out what kind of brace i have, its a milwakee brace, but i cant spell.

[LindaRacine]

The article from which you quoted was written by a chiropractor, and as far as I can tell, has absolutely no basis in fact. I have never seen anything in the literature linking any type of scoliosis brace to flatback.

--Linda

[chic xx chic]

i like never heard anything like that before.. =p

[structural75]

Scoliosis_Gal,

Some doctors don't have that type of perspective on things... they tend to get fixated on the isolated "parts" in question and neglect to consider the global affects.

On the otherhand, some Doctors do consider the global picture...Dr. Pashman :Obviously this pertains to surgery, but it applies to bracing as well.

Interestingly enough, much of our awareness of flat back dates from our early experience with surgical instrumentation intended for the treatment of thoracolumbar scoliosis and degenerative spine disease. The Harrington rod and other similar devices produce correction of scoliotic lumbar deformities by utilizing distraction or lengthening forces in the concavity of the curve.

Although the curve is straightened in the front view plane, the same distraction forces applied to the concavity of the curve in the side view plane produce straightening of the lumbar lordosis and forward decompensation of the spine.

Yes, in fact the same applies to rigid bracing. The circumferential forces applied by these braces not only use force to correct the lateral scoliotic curvatures, but the anterior/posterior primary and secondary curves of the spine as well. It is not necessarily intended to do such (as the primary and secondary curves of our spine are supposed to be there for healthy function), but because the rigid braces are applying static force around the whole torso, it may create a reduction in lumbar lordosis, or flexion of the lumbar spine (a.k.a. -"flat back syndrome"). Furthermore, the immobilizing nature of the rigid brace will inhibit spinal mechanics and consequently the activity of deep postural muscles in the spine that are meant to help appropriate the balance of these A/P curves... leaving them susceptible to a "flat back" position. There are further implications that affect the pelvis, knees ankles, etc... . In fact this problem occurs far more often than is recognized, and is one contributing factor in the 'secondary' spinal problems people face (discs, facets, etc.).

I believe it would be hard to find it in some literature because it hasn't been considered, or acknowledged as a consequential effect by many. Or few have found the need to document it... unfortunately deeming it as 'inconsequential'. Most importantly though, it's basis is rooted in biomechanical, neurophysiological and neurofascial science. It does have much truth to it.

The spinecor has the advantage of being non-rigid and permits functional movement, therefore, I think the concern you have about "flat back" is probably not applicable to it.

structural

[Karen Ocker]

Bracing causing flatback???

I searched the National Library of Medicine for this but found no references for rigid bracing causing flatback syndrome(which I suffered from before my revision). The causes I found were long fusions which did not maintain the normal lordotic lumbar curve and the old Harrington Rod system which sometimes had the same effects. Nothing attributing it to bracing. Wouldn't proper brace fitting take this into account? Also, when the brace is removed-and it's not worn continuously, and since the spine is not fused, why would the spine remain "flatbacked".

I sent an e-mail for clarification.

[SandyC]

OH, GOOD GRIEF Here we go again with the "misinformation" from some chiropractic site. Will people not learn?????????

[structural75]

Karen,

Many people have "flat back syndrome" who don't have vertebral fusions or scoliosis and therefore didn't where a brace either. In fact my wife had it following a car accident 10 years ago. Prior to the accident she had a 'normal' lumbar curve, immediately following she lost it altogether. That remained, along with 3 collapsed discs for several years until receiving treatment of an 'unproven' variety. Now she has a 'normal' lumbar curve again (as shown with x-ray comparison, before and after), no back pain and carried/gave birth to our daughter with no typical "pregnancy/labor back pain" to speak of.

I don't think we'll find that in the medical libraries either, but it was certainly the reality.

Why would it remain flat without being fused? Fusions aren't the only cause or factor involved in flat back (I see it quite often in practice for a variety of reasons). As it relates to scoliosis, it remains in that position as a result of the tonic muscular inhibition to the deep postural muscles and ligaments of the spine, reinforced and caused by wearing a rigid (immobile) brace. Pelvic positioning also comes into play as does the position of the ribcage/thoracic spine relative to the pelvis while wearing the brace. If the malpositioning is just so, it will cause an entirely different tonic reflex pattern throughout the body, including the spine, which is then maintained when the brace is periodically removed. And since most bracing is worn more often than not to make it effective, within a few months that will become the persons new postural orientation as the connective tissue network lays down new collagen fibers to accommodate the new positioning. In the midst of all of this the shape of the vertabrae and intervertebral discs becomes malformed thus perpetuating the problem.

Sorry if that was a bit long-winded, does that answer your question at all?

I agree with you Karen, it certainly doesn't happen to everyone who wears them. It's not synonomous with rigid bracing, but a potential effect even with proper fitting.

Regards,
Structural
p.s. - Basis in fact in this situation is derived from actual occurrence in the clinical setting more-so than documentation in a library. Things that are not observed due to oversight can't find their way into the literature. I'm sure that all of the effects of rigid bracing on the body have not been documented. But hopefully it is given more and more consideration in the future, given the number of degenerative disc conditions that arise down the road for many who've had this type of bracing.

[Karen Ocker]

Thanks for your reply. I guess there is always something new to discover.

[valger]

Flat back syndrome

Hi all~~
I am fairly new to this site, and really getting alot of important information on here so far, so thank you!!
I was surprised to hear the mention of Dr. Deutchman, I had been researching online and also ran into the SpineCor site. I actually sent them an e-mail, and he and I have been playing phone tag for a while. I was very curious about their product, they say that their type of "brace" is much better than a plastic, rigid brace, and dosen't contribute to any of that unwanted secondary stuff that can happen in the typical Boston brace.
My daughter is almost 13, and been in the Boston TLSO for about a month, and doing well so far. She is really being brave about it, not complaining at all. I'm the one that is doing all the stressing out! We just went Friday to have her brace readjusted, and he tightened it quite a bit. Are they supposed to do that? I was surprised that he did that, she had just gotten used to the brace, and now it is sort of back to the beginning again as far as her being uncomfortable, and just getting used to it. Do they do that every month? After the adjustment, we went to the Orthopedic surgeon, and he said that she looks great in her brace, and that she appears to have an 11 degree curve, I am not sure what that means. She started off with a 35 degree curve, she got the brace on January 26th. He emphasized the word "appears".....I think, meaning that if the brace were to come off, it would go back to something in the 30's, but that the brace is holding it at 11 while it is on. I was surprised at the difference in numbers, I didn't know that you could improve the curve so fast. She still looks the same to me, as far as when she bends over, she has the slight 'rib hump', so I'm not sure about the 11 degrees. He said her spine is flexible, and I guess that is good(?) Anyway, I was also basically wondering if any of you know about Dr. Deutchman and the practice. What is wrong with chiropractors? I don't know if this is too good to be true, or what. Our specialist says that chiropractors don't help. I think they do help for back pain, but I think that he was making sure we wouldn't forego medical treatement for chiropractic treatements. I was interested in it initially because it showed a girl doing ballet with their type of "brace", and that is what my daughter does. She is very involved with ballet, and we hope that she can keep it up. Anyway, thanks for any advice! Good luck, Val

[braceguy76]

Chiropractors

I would recommend that you try a Orthopedic Surgeon who is willing to fit you with the spine-cor brace.It's sound as if your Daughter my be a canidate for Spine-cor but keep in mind that there is no real third party study that suggest that it is any more effective then your daughters current treatment.

If you have insurance and you use a MD, An orthopedic surgeon and he orders the brace it would be it by a Certified Orthotist and billed to your insurance. the amount billed is around 2500.00 which depending on you plan could be covered up to 80%. However if thing start to go south fast and surgery become your best option you are under the care of a MD.This is the same with pain issues.

[MATJESNIC]

My daughter takes ballet, tap, and jazz. Ballet with the Spinecor brace is great. Last year my daughter danced 6 days a week with her brace on. Ballet is excellent for scoliosis. I even made a dvd of Nicole dancing in her brace for Dr. Rivard in case he wanted to use it at any of his conferences.

Movement is life. Life is good.

[valger]

Spincor vs. hard brace

Hi all~~
thanks so much for the responses! I had one question, why would they take an eye test? I was worried for a while about my daughter having Marfan's, because of some things I looked up on the internet on my own. We had just found out she had scoliosis, and then I happened to go to a Marfan's site, and she seemed to possess some of the characteristics to me, (however, I am a BIG worrier)....but none of the doctors seemed concerned. She dosen't wear glasses, but I have never really had her eyes checked other than at school. She is fairly tall, and has long fingers. But, my husband said that she is proportionate, and the Orthopedic Surgeon agrees. He totally blew off the Marfan thing when I mentioned it, saying she would be taller, and have other characteristics. That did make me feel alot better! But, I was just wondering what you meant by the eye test, and wondering if that was to help rule out Marfan's as a possible symptom of Marfan's. I suppose many thin, tall girls have scoliosis that don't have Marfan's. And, she's not really all that tall, she is thin, but I notice at school, that there are alot of girls around her height.
Thanks so much for the encouragement about the ballet!! It's been so important to her, and such a big part of her life! We have a great ballet that we go to here, that has a spring performance each year, and the Nutcracker each year also. So, she really enjoys it, and we thought at first that she might have to give it up, but we are so happy to find out that it should be a good thing to keep taking it. I'm not sure if she could be a professional ballerina as she wants to, but we are taking it day by day!
Thanks again, and talk to you soon! Oh, and by the way, you do think it's normal then that he tightened the brace so much on her second visit? I was thinking that since the curve appeared to go down so much, why not just leave the brace as it was? This was the guy that adjusts her brace, not the Ortho. She seems fine with it, just it's so much tighter, and she seems more uncomfortable. Thanks, Val