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Successful use of braces such as LSOs may lead to decreased pain, increased strength, improved function, increased proprioception, improved posture, correction of spinal deformity, protection against spinal instability, minimize spinal problem complications and improve the healing of ligaments and bones. The two types of bracing commonly used in an outpatient office are the soft brace which limits some movement and is used for lifting occasions such a employment requiring the lifting of heavy loads. The other is a rigid brace which could be a form fitting plastic type mold that restricts motion by as much as 50% and is used for low back pain and instability when non-rigid (soft) bracing is not enough. Hard braces offer both immobilization and support.6

Common Examples

Here are a few examples of patient presentations I commonly see in my practice.

Example 1: The patient has a history of reoccurring low back pain that seems to be worsening over time. She does not want back surgery. Conservative care helps for a while but it seems to take longer to get better now and never seems quite "right." X-rays show a pars defect with slippage of L5. Diagnosis is Spondylolithesis Grade 1, with instability. Application of semi-rigid LSO for acute stage and for home use under exacerbation stages. Also recommended to use when in dangerous activities that could trigger back syndrome exacerbation.

Example 2: The patient presents with a history of chronic low back pain, has been to many doctors, has had no real help yet and is worsening. Range of motion of the lumbar spine exhibits both pain and limitations, x-ray show slippage of l4 on L5, grade 2 without pars defect. Diagnosis is degenerative spondylolitheses with lumbar instability. As part of a treatment plan, application of rigid LSO for core stability is delivered.

Example 3: Patient presents with a history of low back pain for no reason. Exam shows antalgia with moderate to severe muscle spasm. Diagnosis is probable disc syndrome. Application of a rigid LSO to facilitate protection and stability is given.

When using LSOs, the treating physician must provide clinical necessity in his notes. Clinical necessity should include some type of instability syndrome or pain syndrome that is to be helped by providing core stability. The LSO would function to provide core stability in both the short and/or long term. While positive clinical results do not always occur, one should document an anticipated prognosis of a positive effect on the patient and the treatment plan. Then, later on in the notes, the documentation should reflect what the actual clinical result is.

Remember, if this LSO is in the best interests concerning the patients back problem, the documentation should be relatively easy and concise. For the patient, they desire less pain and less episodes of difficulty. This, in turn, clearly leads to a better quality of life for the patient. For the physician, this means functional improvement and success in the goals of care and the physician is well paid for his efforts. Concerning the fiscal impact to the patient, the insurance payers, and society at large, this means less money is "burned up" taking care of patients with these problems. Everybody wins!

I love the fact that, as a chiropractor who is a certified Medicare provider/supplier for DME, I am able to help patients with a "gold standard" method of care, am able to do so with a minimum of effort in time and documentation requirements and am paid handsomely for it.

References:

  1. Lumbar corsets: compliance and effectiveness for lower back pain, Khan AM, Salih M, Lnach B, Department of Orthopedics and Trauma, King George Hospital and Northwich Hospital, Essex, Hong Kong Journal of Orthopedic Surgery, 2002:6 (1): 1-2
  2. USF OSHA Training Institute Education Center, Robert Nesbit, Program Manager and USF SafetyFlorida Consultation Program, Charlene Vespiletter, Program Manager, to Bill Cavalieri, Sr., CEO, Lifeback Enterprises, November 1, 2008
  3. University of Maryland Spine Program, a Patient's Guide to Back and Neck Braces
  4. Dupry Spine, Inc.
  5. Wikipedia
  6. Colorado Comprehensive Spine Institute

Dr Antos has been in private chiropractic practice for 34 years. In 2011 and 2012, he was a lecturer for Florida State License renewal on behalf of the Florida Chiropractic Association, teaching on the topic "DME and Lumbar Bracing." For more information on the credentialing process, contact Dr. Antos at (386) 212-0007 or visit www.antosdmebrace.com.

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