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A CASH brace is a cruciform anterior spinal hyperextension orthosis: a cross-shaped front frame with a chest pad, a pelvic pad and two rib pads, held on by a strap that passes around the body. It keeps the spine extended and prevents forward bending. This page describes products and general use; it is not medical advice.
Who uses it: orthotists, clinic and orthotics staff, buyers and students who need to tell a CASH orthosis apart from other spinal braces.
What a CASH brace is
CASH stands for Cruciform Anterior Spinal Hyperextension. St Vincent’s Hospital Melbourne’s prosthetics and orthotics department describes it as a device used following bony or ligamentous spinal injuries, after surgery or during rehabilitation to maintain the spine in a fully extended (straight) position and prevent forward bending.
It is a front-loaded brace: the frame sits across the front of the body rather than wrapping the trunk like a corset or a rigid shell. For how it fits among other spinal braces, see back brace types.
How it works and how it is built
The St Vincent’s leaflet lists four contact points: a chest pad, a pelvic pad and two rib pads, joined by a cross-shaped frame across the front of the body and held in place by a strap around the body.
The mechanism is described in US Patent 5,135,471. The cruciform orthosis applies a force to the front of the body and a balanced force to the back. The front force comes from two pads, one at the pubic area and one at the sternum, and a back strap engaging the lumbar area provides the balancing force. For the general principle behind rigid and semi-rigid back supports, see how a back brace works.
Where the design came from
The patent records that the cruciform orthosis was disclosed in US 4,173,973, “Hyperextension Back Brace”, issued 13 November 1979 to David J. Hendricks (reissued as RE 31,564 on 24 April 1984). It also cites a commercial version, the catalog sheet “The CASH Orthosis” by Ralph Storrs, Inc., copyright 1985.
The same patent explains a known design problem: some patients suffer discomfort because the sternal pad rests on the sternum, where there is very little muscle and fat to spread the load. Earlier fixes used a T-support with two pectoral pads, and the patent proposes a version with side pads. A patent is design history, not clinical evidence, so it shows why pad placement matters in this device rather than how well any version performs.
CASH vs Jewett vs LSO/TLSO
A CASH is defined by its front cross-shaped frame and four pads (chest, pelvis, two ribs) with one strap around the body, so it is a different design from a lumbosacral or thoracolumbosacral orthosis (LSO/TLSO). The Jewett brace page has the side-by-side comparison of Jewett, CASH and LSO/TLSO, and the LSO brace guide covers the other type.
Fit landmarks
The hospital leaflet describes a correctly positioned CASH by these landmarks:
- The cross sits in the middle of the chest.
- The top of the brace sits just below the top of the breast bone.
- The bottom sits just above the pubic bone.
- The cross bar lies over the ribs.
Fitting and adjustment are done by the treating orthotist.
Handling and labelling basics
Fitting, adjustment and any change to the frame are done by the treating orthotist, and the manufacturer’s instructions for use and your treating team’s instructions govern the device. Check the product label for the manufacturer, model and size markings.
US regulatory class
Under 21 CFR 890.3490, a truncal orthosis is a device intended for medical purposes to support or immobilize fractures, strains or sprains of the neck or trunk. The regulation classifies it as Class I (general controls) and exempts it from premarket notification (510(k)), subject to the limitations in 890.9. It is also exempt from the quality management system requirements of part 820 except records and complaint files under 820.35. Class I and 510(k)-exempt describes the regulatory pathway; it is not a statement about how effective a particular brace is.
Common mistakes
- Treating all hyperextension braces as one product. Compare structure before assuming two devices are interchangeable, starting with the Jewett brace.
- Reading Class I or 510(k)-exempt status as a statement about effectiveness. It describes the regulatory pathway only.
- Treating a patent as clinical evidence. It documents design, not outcomes.
FAQ
What does CASH stand for?
Cruciform Anterior Spinal Hyperextension, describing a cross-shaped frame worn on the front of the body that holds the spine extended.
What is a CASH brace made of?
A chest pad, a pelvic pad and two rib pads connected by a cross-shaped frame, with a strap that passes around the body.
How is a CASH brace different from a Jewett brace?
Both are anterior hyperextension designs, but a CASH is defined by its cross-shaped front frame with chest, pelvic and two rib pads and one strap around the body. The Jewett brace guide has the side-by-side comparison.
Is a CASH brace regulated by the FDA?
A truncal orthosis falls under 21 CFR 890.3490: Class I, exempt from 510(k) subject to 890.9.
Sources
- St Vincent’s Hospital Melbourne, Prosthetics and Orthotics, Cruciform Anterior Spinal Hyperextension Orthosis (patient leaflet 393 V1, 12/10/2015), checked 2026-10-31.
- US Patent 5,135,471, Cruciform anterior spinal hyperextension orthosis, checked 2026-10-31.
- eCFR, 21 CFR 890.3490 Truncal orthosis, checked 2026-10-31 (text confirmed at Cornell LII, https://www.law.cornell.edu/cfr/text/21/890.3490).
Related: back brace types, LSO brace.
