A RATIONAL BRACE 
FOR THE TREATMENT 
OF 
Garies H y <^rtebrae 
(POTTS’ DISEASE). 
BY 
CHARLES F. STILLMAN, M. Sc., I).. 
Of Chicago. 
(Member of American Ortliopcedic Association.) 
REPRINTED FROM THE 
NORTHWESTERN MEDICAL JOURNAL. 
1890. A RATIONAL BRACE 
FOR THE TREATMENT 
OF 
Garies "Vertebrae 
(POTTS’ DISEASE). 
BY 
CHARLES F. STILLMAN, M. Sc., M. D., 
Of Chicago. 
(Member of American Ortbopoedic Association.) 
REPRINTED FROM THE 
NORTHWESTERN MEDICAL JOURNAL. 
1890. THE HOUSEKEEPER PRINT, 
16, 18 and 20 N. Fourth St., 
Minneapolis, Minn. A RATIONAL BRACE FOR THE TREATMENT OF 
CARIES OF THE VERTEBRAE 
(.POTTS’ DISEASE). 
By Charles F. Stillman, M. Sc., M. D., of Chicago. 
(Member American Orthopoedic Association.) 
Iii studying the mechanical problem involved in the 
treatment of spondylitis, there are two factors which 
must be recognized: 
1. Arrest of the disease. 
2. Reduction of the deformity. 
Nature points out the direction in which force should 
be applied to produce curative results. Who has not 
noticed the position assumed by a patient with caries 
°f Hie spine? The body is held rigidly erect, the head 
and shoulders are thrown back, and in stooping to pick 
an object from the floor, this position is still main- 
tained, the patient having every muscle exercised to 
hold the spine perfectly fixed and bent backward, the 
position being similar to that of an equestrian. 
ere it possible for this position to be maintained 
continuously, progress of the disease to the stage of 
deformity would be almost impossible; but it is a nat- 
ural tendency for the patient to bend forward, and the 
act of bending forward removes the superincumbent 
weight from the articular processes, and proportion- 4 
ately transfers it to the bodies of the vertebrae and 
their intervening cartilages. The muscles are unable 
to continue supporting the spine in the hyper-erect po- 
sition at all times, and as a natural consequence of the 
occasional bending forward, increased pressure is ex- 
erted upon the diseased vertebral bodies and a has- 
tened absorption of their structure, resulting in the 
formation of deformity, ensues. 
Nature’s indication for the treatment of Potts’ dis- 
ease is to put a splint on the back of the patient which 
Fig. 1. Showing appearance of kyplios in spinal caries. 
will maintain this erect position, for, since the ten- 
dency of the disease is to curve the affected portion of 
the spine forward, the center of this curve being an- 
teriorly, the corrective force should be applied to pro- 
duce exactly an opposite curve to that of the diseased 
condition, the center of such a corrective curve being 
posterior to the column. In other words, we must 
follow Nature’s lead and hold the spine erect and 
slightly curved backward, the tendency of the disease 
being to bend it forward. If this position could be 5 
maintained indefinitely without mechanical support, 
there would be rapid improvement; but, as this is ob- 
viously impossible, we attempt to embody the forces 
involved into a brace constructed in two parts. The 
first portion of the brace, forming the short arm of the 
lever, consists of a firm pelvic band, from which two 
strong strips pass upward, and terminate in two piv- 
oted oblong pads, one on either side of the protruding 
spinous processes of the diseased vertebrae, and press- 
Fig. 2. Stillman’s brace for lower dorsal region partially applied. 
ing over the transverse processes. These are placed 
just sufficiently far apart not to impinge upon the 
spinous processes, and thus the excoriation so often 
produced by plaster and leather jackets is entirely 
avoided. 
The second portion of the brace, equivalent to the 
long arm of the lever, consists of a back frame, ex- 
tending from the lower portion of the sacrum upward 
to the first dorsal vertebra; and is secured to the pelvic 6 
girth by ratchets or clamps which allow it to be ad- 
justed at any angle, and thus regulate the amount of 
forward pressure upon the kyphos. 
The angle at which this back frame or long arm of 
the lever is set out from the body (see Fig. 2) deter- 
mines whether the brace shall act as a lever brace or 
as a simple fixation brace. If adjusted as shown in 
Fig. 2, and secured to the body (as in Figs. 3 and 4) 
this brace forms a Y-shaped spring lever which pro- 
duces backward extension of the bodies of the verte- 
Fig. 4. The same—rear view. 
Fig. 3. The same applied. 
brae, and thus tends to arrest the disease and improve 
the deformity, while it maintains the spine firmly in 
the ereet position at the same time. 
There are other features of this brace which deserve 
mention. It will be observed that, if the angle be- 
tween the short and long arms of the lever is consider- 
able, when the long arm is fastened firmly to the body, 
the bending forward tendency of the upper part of the 
trunk does not cause the spine to give way at the seat 7 
of disease; for, in proportion as the patient leans for- 
ward, the short arms press forward upon the kyphos 
and oppose a resistance to the bending at that point, 
so' that by the brace a curative automatic effect is 
maintained to keep the body erect and at the same 
time prevent further deformity, while tending to im- 
prove that which already exists. Furthermore, the 
spring effect produced by the setting off of the trac- 
tion-frame and drawing it forward against the body, 
which is thus held erect when properly strapped, 
causes the brace to be held more tightly against the 
back, and insures a higher degree of fixation than any 
other form of apparatus in use. In the beginning of 
the treatment it is well to have the traction-frame set 
off at such an angle as to cause considerable pressure 
upon the transverse processes of the vertebrae, and in- 
sure thorough extension of the diseased portion. But 
this angle mav be lessened week by week as the case 
improves, until finally the traction-frame lies directly 
upon the pads, and the brace becomes a mere fixation 
brace, without any leverage whatever. To further il- 
lustrate the action of the brace, if a bent lead strip is 
Fig. 5. Brace for middle dorsal region. 8 
taken, and one extremity held firmly by one hand with 
the thumb pressed against the knuckle, it will be found 
that a force comparatively slight (when contrasted 
with that used in linear traction to produce a less per- 
fect result) with the other hand will serve to straighten 
the rod into its original position. 
This is precisely what is accomplished by this brace. 
We grasp firmly the lower part of the spine as high as 
the seat of disease, and then, by force applied above, 
Fig. 6. Brace for upper dorsal region (applied). 
bend the spine backward sufficiently to relieve the 
bodies of the vertebrae from pressure, and at the same 
time with the short arm of the lever (corresponding to 
the action of the thumb upon the lead strip), press for- 
ward upon the deformity, and thus, by the use of a 
very light frame-work, we can exert sufficient lever- 
age to retain the spine in an erect posture; and, as 
this backward force is distributed along the entire dor- 
sal and lumbar spine, while the forward is exerted 
onl}T along the spine from the seat of disease down- 9 
ward, decreasing from the kyphos to the sacrum, it 
will be found that no injurious pressure is exerted at 
any one point. For the middle dorsal region the short 
arms of the lever are longer than for the lower dorsal, 
so as to be opposite the seat of disease, as in Fig. 5. 
For the upper dorsal region the short arms pass to the 
seat of disease, making a very effective brace for this 
region (see Fig. 6) which is generally considered to be 
the part of the spine least amenable to mechanical 
Fig. 7. Brace for caries of the lower lumbar vertebra (armlicdV 
treatment. For the cervical region, or for caries of 
the first and second vertebrae, the brace shown in Fig. 
0 should have added to it a jury-mast or a head-piece, 
which is provided with facilities for fixing the head 
firmly in any desired position, by the insertion in the 
neck-strip connecting the head-piece with the rest of 
the brace, of three clamps which are so placed as to se- 
cure this result. The’choice between the jury-mast 
and fixed head-piece in these cervical cases is usually 
one which the surgeon is called upon to decide for 
himself, and is to some extent regulated by the gravity 10 
of the condition, the latter being more effective in 
caries which is proceeding very rapidly in its course. * 
When the disease is situated in the lumbar or in some 
cases in the lower dorsal region, and the ‘short arms of 
the lever are too short to exert sufficient forward press- 
ure upon the kyphos, the lever is reversed, the point of 
intersection of the long and short arms being placed in 
the dorsal region instead of over the sacrum. From 
this the short arm lever strips pass down on either side 
of the spine to the seat of disease where they terminate 
in pads, and the long arm of the lever passes to the 
sacrum, there terminating in the pelvic girth. 
Advantages of braces constructed on the Vprinciple: 
I. They hold the spine rigidly in the erect position 
and at the same time bring automatic spring pressure 
to bear at the seat of disease, thus producing the very 
best conditions for rapid and complete recovery. 
II. They are removable at pleasure, and can lie 
worn over an undershirt, so that absolute cleanliness 
can be secured. 
III. The power is adjustable, so that changes can 
be made during the different stages of the disease 
without the necessity of purchasing other apparatus. 
IV. They can be worn with perfect ease and com- 
fort. 
Y. Those provided with acromial pads do not in 
the least impede respiration, but rather tend to increase 
its capacity by holding the shoulders back. 
VI. By their combined backward traction and for- 
ward pressure, they retain the spinal column in a con- 
dition of absolute rest, and at the same time relieve 
the diseased parts from the pressure of the superin- 
cumbent weight, and reduce deformity. 
The principle upon which these braces are constructed 
is a new one in orthopaedic surgery, and, is original with 
the writer, and its range of utility is not confined to 
caries of the spine but extends to many other deformi- 
ties. 
* For such cases, the constant use of the recumbent spinal exten- 
sion frame is recommended. (See Western Medical Reporter, Feb- 
ruary, 1890.)