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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
Q

DDD Segmental Hyperextension

A

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
Q

Disc Herniation

A

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
Q

DDD Treatment Goals

A

Mild Activity preferred for better healing

28
Q

DDD Typical TLSO

A

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
Q

Cervical Spine

A

Flexibility (turning head)

30
Q

Thoracic Spine

A

stability protection of organs

31
Q

Lumbar Spine

A

axial loading and movement (lifting objects)

32
Q

Conditions Treated with TLSO

A

DJD
DDD
Osteoporosis
Anterior Compression Fractures
Stable Burst Fractures
Post Operative

33
Q

Osteopenia

A

loss of bone density commonly seen > 50 YO

34
Q

Osteoporosis

A

profound bone loss
bone mineral density greater than 2.5

35
Q

Anterior Compression Fractures Indications

A

T4-T9 level stable fractures
sometimes L3-L5
T10-L12 fractures, usually with specific hyperextension TLSO

36
Q

Anterior Compression Fracture Treatment Goals

A

6-12 weeks in CF TLSO or corset

motion control helps to relieve acute pain and reduce loss of height

37
Q

Typical TLSO Anterior Compression Fracture

A

CF TLSO Corset
CF TLSO sagittal-Coronal, Anterior Coronal or Triplanar body jacket

38
Q

Stable Burst Fracture

A

no neurologic injury, subluxation, dislocation
angulation of the spine less than 20 degrees
spinal canal compromise less than 50%

39
Q

Stable Burst Fracture Treatment Goals

A

restrict gross spinal motion during healing
reduce loading on fracture
allow mobilization of patient

40
Q

Stable Burst Fracture TLSO

A

custom made TLSO- triplanar body jacket
total contact

41
Q

Flexible

A

Usually elastic material
spinal belt or wrap
OTC

42
Q

Semi-Rigid

A

Flexible but non elastic fabric
metal/plastic stays/panels
Orthopedic corset
custom fitted CF

43
Q

Rigid

A

Aluminum or plastic structure
spinal brace
CF or CM

44
Q

Posterior LSO Fitting Parameters

A

paraspinal uprights: follow muscle apices
Top: 10 mm inferior to most inferior angle
bottom: sacral coccygeal junction

45
Q

Lateral LSO Fitting Parameters

A

Lateral uprights: mid-axillary line
top: clearance at axilla
Bottom: 10 mm trochanteric clearance

46
Q

Anterior LSO Fitting Parameters

A

Top: 10 mm inferior to xiphoid
Bottom: 10 mm superior to symphysis pubis
sufficient relief when seated for rectus femoris m
total contact

47
Q

Posterior TLSO Fitting Parameters

A

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
Q

Lateral TLSO Fitting Parameters

A

Shoulder Straps: deltopectoral groove
Lateral Uprights: mid-axillary line
Top: Clearance at axilla
Bottom: 10 mm trochanteric clearance

49
Q

Anterior TLSO Fitting Parameters

A

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
Q

CF LSO: Sagittal Control

A

Chairback brace

resists flexion and extension only

canvas or elastic anterior panel

non elastic pelvic strap

lateral uprights

51
Q

CF LSO: Sagittal Coronal Control

A

Knight

resists flexion/extension and lateral motion

canvas or elastic anterior panel

non elastic pelvic strap

52
Q

LSO Posterior Coronal Control

A

dynamic orthosis resists extension and lateral motion but encourages lumbar flexion

rarely used today

53
Q

CF TLSO: Sagittal Control

A

Taylor

higher configuration increases control of upper thoracic spine

canvas or elastic anterior panel

non elastic pelvic strap

54
Q

CF TLSO: Sagittal Coronal Control

A

Knight & Taylor

resists flexion/extension and lateral motion

canvas or elastic anterior panel

non-elastic pelvic strap

55
Q

CF TLSO Tri-planar Control

A

plastic body jacket

anterior, posterior openings or overlap

low risk applications (CF)

56
Q

Clinical Questions for MD

A

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
Q

Basic Fitting Protocol

A
  • fit supine
  • log roll
  • locking elbows
  • snug closures and verify comfort

SPINAL (9 decks)

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