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SPINAL > Intro to Custom Fitted LSO and TLSO (Quiz 2) > Flashcards

Intro to Custom Fitted LSO and TLSO (Quiz 2) Flashcards

1
Q

Lumbar Spine Characteristics

A

Compensatory lordotic curve to balance trunk over hips
Largest vertebrae to bear axial load of body

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2
Q

Where is greatest loading in lumbar spine

A

L5-S1

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3
Q

L5-S1

A

rotary motion over fixed base

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4
Q

L1-L2

A

Spinal cord ends
cauda equina begins

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5
Q

LSO Motion Control

A

3 point pressure systems
total contact (custom made only)

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6
Q

What conditions are treated with LSO

A

spondylosysis
spondylolisthesis
ankylosing spondylitis
spinal stenosis
degenerative joint disease
degenerative disk disease

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7
Q

Spondylolysis

A

Stress fracture or defect in the pars interarticularis
usually L5
most common cause of LBP seen on radiographs in children and adolescents
short term brace wear

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8
Q

Spondylolisthesis

A

anterior migration of one vertebral body over another
most common L5-S1 or L4-L5
muscle spasms or nerve impingement

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9
Q

Newman Grading - Slip Angle 50/50 Rule

A

safe to manage up to Grade II displacement and slip angle up to 50 degrees with orthosis

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10
Q

Treatment Goals for Spondylolithesis

A

restrict lumbar sagittal hyperextension
Reduce lumbar lordosis
encourage lumbar flexion

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11
Q

Typical LSO for Spondylolisthesis

A

CF LSO Corset
LSO Triplanar control (body jacket)

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12
Q

Ankylosing Spondytis

A

hereditary spinal arthritis = inflammation of spinal joints and adjacent structures leading to progressive and ascending bony fusion of the spine

decreased lumbar lordosis, decreased sagittal and coronal motion

decreased chest expansion as AS progresses into T spine

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13
Q

Treatment goals ankylosing spondylitis

A

pharmacological relief for pain
PT to maintain mobility
education about prognosis

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14
Q

Typical LSO for Ankylosing

A

rarely, use CF or CM LSO Corset to reduce discomfort and accommodate spinal deformities

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15
Q

Spinal Stenosis

A

narrowing of the spinal canal or neural foramina
nerve root compression

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16
Q

Spinal Stenosis Central

A

symptoms: pain and paresthesias with ambulation and extension
spinal flexion or lying supine give relief
treatment: rest, isometric abdominal exercises, NSAIDs, weight reduction

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17
Q

Spinal Stenosis Lateral

A

Hypertrophy of ligamentum flavum or ventral facet joint capsule
commonly seen with central stenosis but can occur in insolation

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18
Q

Spinal Stenosis Lateral Treatment Goals

A

Pharmacological relief for pain
PT to strengthen core
Surgery if conservative treatment fails

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19
Q

Spinal Stenosis Lateral Typical LSO

A

rarely, use CF LSO Corset to reduce discomfort

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20
Q

Degenerative Joint Disease

A

LBP most common of all musculoskeletal symptoms

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21
Q

DJD treatment goals

A

pharmacological relief for pain
PT strength, flexibility

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22
Q

DJD Typical TLSO

A

rarely
CF TLSO Corset or CF TLSO to reduce discomfort and decreased gross thoracolumbar motion

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23
Q

Degenerative Disc Disease

A

intervertebral discs gradually change from supple flexible state that allows fluid movement, to a stiff rigid state that restricts movement

24
Q

DDD Segmental Instability

A

FSU motion is no longer smooth but becomes irregular and eventually excessive

Traction spurs and osteophytes may occur

25
DDD Segmental Hyperextension
Degenerative changes, flabbiness, and obesity increase lumbar hyperextension, placing anterior fibers loss of articular cartilage, osteophytes and wearing down of subchondral bone may cause pain
26
Disc Herniation
Pain is caused as NP stretches AF Most Common levels: L4-L5, L5-S1, L3-L4 may compress or stretch nerve root as it leaves intervertebral foramen
27
DDD Treatment Goals
Mild Activity preferred for better healing
28
DDD Typical TLSO
May use CF TLSO Corset or CF TLSO to reduce discomfort and decrease gross lumbar motion during healing phase orthoses provide spectrum of control
29
Cervical Spine
Flexibility (turning head)
30
Thoracic Spine
stability protection of organs
31
Lumbar Spine
axial loading and movement (lifting objects)
32
Conditions Treated with TLSO
DJD DDD Osteoporosis Anterior Compression Fractures Stable Burst Fractures Post Operative
33
Osteopenia
loss of bone density commonly seen > 50 YO
34
Osteoporosis
profound bone loss bone mineral density greater than 2.5
35
Anterior Compression Fractures Indications
T4-T9 level stable fractures sometimes L3-L5 T10-L12 fractures, usually with specific hyperextension TLSO
36
Anterior Compression Fracture Treatment Goals
6-12 weeks in CF TLSO or corset motion control helps to relieve acute pain and reduce loss of height
37
Typical TLSO Anterior Compression Fracture
CF TLSO Corset CF TLSO sagittal-Coronal, Anterior Coronal or Triplanar body jacket
38
Stable Burst Fracture
no neurologic injury, subluxation, dislocation angulation of the spine less than 20 degrees spinal canal compromise less than 50%
39
Stable Burst Fracture Treatment Goals
restrict gross spinal motion during healing reduce loading on fracture allow mobilization of patient
40
Stable Burst Fracture TLSO
custom made TLSO- triplanar body jacket total contact
41
Flexible
Usually elastic material spinal belt or wrap OTC
42
Semi-Rigid
Flexible but non elastic fabric metal/plastic stays/panels Orthopedic corset custom fitted CF
43
Rigid
Aluminum or plastic structure spinal brace CF or CM
44
Posterior LSO Fitting Parameters
paraspinal uprights: follow muscle apices Top: 10 mm inferior to most inferior angle bottom: sacral coccygeal junction
45
Lateral LSO Fitting Parameters
Lateral uprights: mid-axillary line top: clearance at axilla Bottom: 10 mm trochanteric clearance
46
Anterior LSO Fitting Parameters
Top: 10 mm inferior to xiphoid Bottom: 10 mm superior to symphysis pubis sufficient relief when seated for rectus femoris m total contact
47
Posterior TLSO Fitting Parameters
Paraspinal uprights: follow muscle apices Top: 10 mm below medial scapular spine bottom of interscapular band: 10 mm above inferior angle Top of thoracic band: 10 mm below inferior angle bottom of pelvic band: sacral coccygeal junction
48
Lateral TLSO Fitting Parameters
Shoulder Straps: deltopectoral groove Lateral Uprights: mid-axillary line Top: Clearance at axilla Bottom: 10 mm trochanteric clearance
49
Anterior TLSO Fitting Parameters
Top: 10 mm below xiphoid Bottom: 10 mm above symphysis pubis Sufficient relief when seated for rectus femoris m provide total contact and intra cavitary support
50
CF LSO: Sagittal Control
Chairback brace resists flexion and extension only canvas or elastic anterior panel non elastic pelvic strap lateral uprights
51
CF LSO: Sagittal Coronal Control
Knight resists flexion/extension and lateral motion canvas or elastic anterior panel non elastic pelvic strap
52
LSO Posterior Coronal Control
dynamic orthosis resists extension and lateral motion but encourages lumbar flexion rarely used today
53
CF TLSO: Sagittal Control
Taylor higher configuration increases control of upper thoracic spine canvas or elastic anterior panel non elastic pelvic strap
54
CF TLSO: Sagittal Coronal Control
Knight & Taylor resists flexion/extension and lateral motion canvas or elastic anterior panel non-elastic pelvic strap
55
CF TLSO Tri-planar Control
plastic body jacket anterior, posterior openings or overlap low risk applications (CF)
56
Clinical Questions for MD
1) is there neurological involvement or risk of progression 2) is this spine considered clinically stable 3) What motions should be limited 4) Is this patient likely to be compliant
57
Basic Fitting Protocol
- fit supine - log roll - locking elbows - snug closures and verify comfort

SPINAL (9 decks)

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