OP - SPINAL

• Orthoses are appliances used to correct and support the spine
• Spinal Orthoses consist of:

  • Cervical Orthosis
  • Flexible Orthosis
  • Rigid Orthosis
  • LS Orthosis (custom molded)
  • TLS Orthosis (pre-fabricated)
  • Orthosis for Scoliosis
• Primary action of Orthoses: Reduce gross spinal motion
• The range of spinal motion reduction depends on the material and design of the orthosis
• Uses of Spinal Orthoses:

  1. Stabilization and maintenance of spinal alignment

  2. Prevention and correction of spinal deformities

  a. Promote fracture healing

  b. Assist in healing with patients with underlying cervical fixation devices

  3. Relief of pain by limiting motion of weight bearing

  4. Reduction of Axial loading of the spine

  5. Provision of effects such as heat, massage, and kinesthetic feedback
• Disadvantages/Drawbacks of Spinal Orthoses:

  1. Prolonged use can lead to atrophy and weakness

  2. Tightness and contractures

  3. Can cause discomfort

  4. Lead to physiological and psychological dependence

  5. Aggravate symptom patterns

  6. Compromise skin integrity due to trapped heat

  7. Might interfere with patients' ADLs
• Cervical Orthosis Classifications:

  • Cervical Collars

  > Soft Collar

  > Hard/Rigid Collar

  > Philadelphia Orthosis

  > Jobst Vertebrace

  • Cervicothoracic Orthosis

  > Yale Orthosis

  > SOMI (sterno-occipital-mandibular-immobilizer) Orthosis

  > Minerva Orthosis

  • Poster Appliances

  > Four-Poster Brace

  > Two-poster / Guilford Brace

  • Halo Device
• Types of Cervical Collars:

  • Soft Cervical Collar

  > Advantages: Does not restrict motion in any plane, can retain body heat

  > Uses: Minor whiplash, cervical spondylosis, post-op adjunct if patient spine is stable

  • Hard Cervical Collar "Rigid Polyethylene"

  > Advantages: Does not limit lateral bending or rotation but can limit flexion & extension

  > Disadvantages: Can cause discomfort in the clavicle area

  > Uses: Immobilization for pre and post-surgery for spinal stenosis and spondylolisthesis
• Types of Cervical Collars (contd.):

  • Philadelphia Collar

  > Advantages: Molded mandibular-angio-occipital support, extends to the upper thorax

  > Disadvantages: Ineffective in controlling rotation and lateral bending, may be uncomfortable

  > Uses: Cervical strain/sprains, stable fx

  • Aspen Adjustable height Malibu Collar

  > Advantages: Limits flexions, extension, lateral bending, and rotation, adjustable chin support

  > Uses: Status post anterior cervical fusion, dens type 1 fx, cervical sprain/trauma & unconscious
• Types of Cervical Collars (contd.):

  • Ocean Back

  > Uses: Used to replace the back of Miami J Collar, can eliminate occipital breakdown for multisystem trauma without sacrificing cervical spine stability

  • Miami J Collar

  > Uses: Immobilization for pre and post-surgery for spinal stenosis and spondylolisthesis

  • Headmaster Control

  > Uses: Very lightweight and flexible, provides limited control only, used to support head in patients with drop head syndrome
• Types of Cervical Collars (contd.):

  • Jobst Vertebrace

  > Uses: Emergency transport, short-term use for post-whiplash injury, acute cervical syndrome, spondyloarthritis, post-operative support
• Cervicothoracic Orthosis Types:

  • SOMI
  • Yale Orthosis
  • Thermoplastic Minerva Body Jacket
• Flexible Spinal Orthoses Types:

  • Sacroiliac Belt
  • Sacroiliac Corset
  • Lumbar Binder
  • Lumbosacral Corset (LS Corset)
• Lumbosacral Corset (LS Corset):

  • Anterior superior border is ½ in below the xiphoid process or above the lower ribs
  • Anterior inferior border is ½ - 1 in above the pubic symphysis
  • Posterior superior border is 1 in below the inferior angles of the scapulae
  • Posterior inferior border is just below the apex of the gluteal bulge (men) / gluteal fold (women)
  • Serves as a reminder to the patient to have proper posture
  • Deloads the vertebrae and discs
• Thoracolumbosacral Corset (TLS Corset):

  • Alternate anterior superior border may terminate just below the costal margin
  • Posterior superior border is approximately at the level of the scapular spines
  • Shoulder straps encircle the axillae, cross posteriorly, and are fastened anteriorly
  • Encompasses the torso and hips
  • Deloads the vertebrae and discs
  • Restricts spinal motions/reminder to restrict motion
• Rigid Spinal Orthoses:

  Basic Components:

  • Thoracic band: Superior border at T9-10, approximately 1 in below the inferior angle of the scapula
  • Posterior uprights (LS & TLS): Superior ends of LS uprights end at the thoracic band, TLS uprights at the level of the lateral aspects of the scapular spines
  • Pelvic band: Lateral ends midway between the greater trochanters and iliac crest, posteriorly above the inferior edge of the sacrum and below the PSIS
  • Full-front abdominal support: Superior border ½ in below the xiphoid process, inferior border 1.3 cm above pubic symphysis, lateral border extends to the lateral midlines or to the lateral uprights
  • Anterior extensions of thoracic band with subclavicular pads (cowhorns)
• Types of Rigid Spinal Orthoses:

  • Chairback Brace: For lower lumbar pathologic conditions, post-surgical support, 3-point system for restricting trunk flexion and extension
  • Williams Brace: Extension & lateral control orthosis, pelvic & thoracic bands joined by lateral uprights, 3-point force system
  • Taylor Brace: Axillary straps attached to superior ends, TLS flexion & extension control, 3-point system against trunk flexion and extension
  • Knight-Taylor Brace: Post-surgical support, TLS flexion & extension control, limits rotation and lateral trunk flexion
  • Jewett Brace: Anterior hyperextension brace, increases lumbar lordosis, for compression fracture of the lower thoracic and lumbar region
• CASH (TLSO) (Cruciform Anterior Spinal Hyperextension Orthosis):

  • 3-point system, contraindicated for unstable spine and burst fracture, used for mild compression fracture of the lower thoracic and thoracolumbar region
• Plastic Body Jacket:

  • Used for maximum orthotic immobilization and control of the spine for unstable fractures involving posterior vertebral elements
  • Thermoplastic material is often used, provides flexion control for the lower and lumbar region
  • 3-point system to resist flexion and extension
• Reisser Table:

  • May be used when taking a plaster cast
  • Repositioning of the spinal segments can be accomplished during the casting procedure
• Orthoses for Spinal Deformities - Scoliosis:

  • Methods of achieving correction include using anti-angulation and derotation pads, muscular exertion, exercise programs, surgical fusion, EF and Biofeedback
• Purpose of Orthoses for Scoliosis:

  • Prevent progression of curves
  • Improve structural alignment by reducing angulation and rotation, and improve trunk stability
  • Reduce pain
  • Improve appearance
  • Improve cardiopulmonary function
• Types of Orthoses used for Scoliosis:

  • CTLS Alignment Orthosis
  • TLS Alignment Orthosis
  • Plaster casts
• Milwaukee Brace:

  • Commonly used for high thoracic curve
  • Extends from the neck to the pelvis and consists of specifically contoured plastic pelvic girdle
  • Has a neck ring connected to metal bars from the front and back of the brace
• Boston Brace:

  • TLSO; for curves in the lumbar, thoracolumbar region or thoracic curves with apices below T8 or lower
  • Concavity over the abdomen to increase intracavitary pressure
  • Works by applying corrective pressure to convex side of the curve
• Miami Brace:

  • For apices below T6
  • Minimal coverage of the anterior-lateral aspect of the thorax
  • Large window on the side opposite to the thoracic pad
• Wilmington Brace:

  • Used for curves with apices below T8
  • Made of orthoplast and encompasses the pelvis of the patient
  • Fitting and fabrication preceded by reduction/distraction via Risser Table
• New York Orthopedic Hospital Orthosis (NYOH):

  • Plastic pelvic and thoracic shell with subclavicular bars and hinged pressure pads
  • Designed to reduce and prevent progression of lumbar, thoracolumbar, and low thoracic curves
• Charleston Brace:

  • Nighttime brace worn while sleeping
  • Molded to the patient while they are bent to the side
  • Applies more pressure and bends the child against the curve
• Providence Brace:

  • Computer-fitted brace worn only at night
  • Provides overcorrection of the spinal curve on the recumbent patient
  • Capable of pushing the curve towards the midline or beyond
• Spinecor:

  • Uses adjustable hands and a cotton vest for flexibility
  • Highly favored by patients for its discretion under clothing
  • Can be worn for 20 hours
• Rigo Cheneau Brace:

  • Has a front closure
  • Applies re-torsional forces and 3 point pressure system to improve spinal alignment
• Orthotic Examination:

  • Pass indicates the orthosis is satisfactory and the patient is ready for training
  • Provisional pass means minor faults exist, generally cosmetic, and the patient can wear the orthosis in the training program
  • Failure signifies a major defect that would interfere with training
• Trunk Orthotic Examination:

  • Pelvic band lies flat on the trunk below the posterior superior iliac spine
  • Pelvic band passes between the trochanters and iliac crest
  • Thoracic band lies flat on the trunk below the scapulae
  • Posterior uprights avoid pressure on bony prominences
  • Lateral uprights extend along the lateral midlines of the trunk
  • Patient can sit comfortably with hips and knees flexed 90 degrees