Intro to Custom Fitted LSO and TLSO (Quiz 2) Flashcards
Lumbar Spine Characteristics
Compensatory lordotic curve to balance trunk over hips
Largest vertebrae to bear axial load of body
Where is greatest loading in lumbar spine
L5-S1
L5-S1
rotary motion over fixed base
L1-L2
Spinal cord ends
cauda equina begins
LSO Motion Control
3 point pressure systems
total contact (custom made only)
What conditions are treated with LSO
spondylosysis
spondylolisthesis
ankylosing spondylitis
spinal stenosis
degenerative joint disease
degenerative disk disease
Spondylolysis
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
Spondylolisthesis
anterior migration of one vertebral body over another
most common L5-S1 or L4-L5
muscle spasms or nerve impingement
Newman Grading - Slip Angle 50/50 Rule
safe to manage up to Grade II displacement and slip angle up to 50 degrees with orthosis
Treatment Goals for Spondylolithesis
restrict lumbar sagittal hyperextension
Reduce lumbar lordosis
encourage lumbar flexion
Typical LSO for Spondylolisthesis
CF LSO Corset
LSO Triplanar control (body jacket)
Ankylosing Spondytis
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
Treatment goals ankylosing spondylitis
pharmacological relief for pain
PT to maintain mobility
education about prognosis
Typical LSO for Ankylosing
rarely, use CF or CM LSO Corset to reduce discomfort and accommodate spinal deformities
Spinal Stenosis
narrowing of the spinal canal or neural foramina
nerve root compression
Spinal Stenosis Central
symptoms: pain and paresthesias with ambulation and extension
spinal flexion or lying supine give relief
treatment: rest, isometric abdominal exercises, NSAIDs, weight reduction
Spinal Stenosis Lateral
Hypertrophy of ligamentum flavum or ventral facet joint capsule
commonly seen with central stenosis but can occur in insolation
Spinal Stenosis Lateral Treatment Goals
Pharmacological relief for pain
PT to strengthen core
Surgery if conservative treatment fails
Spinal Stenosis Lateral Typical LSO
rarely, use CF LSO Corset to reduce discomfort
Degenerative Joint Disease
LBP most common of all musculoskeletal symptoms
DJD treatment goals
pharmacological relief for pain
PT strength, flexibility
DJD Typical TLSO
rarely
CF TLSO Corset or CF TLSO to reduce discomfort and decreased gross thoracolumbar motion
Degenerative Disc Disease
intervertebral discs gradually change from supple flexible state that allows fluid movement, to a stiff rigid state that restricts movement
DDD Segmental Instability
FSU motion is no longer smooth but becomes irregular and eventually excessive
Traction spurs and osteophytes may occur
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
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
DDD Treatment Goals
Mild Activity preferred for better healing
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
Cervical Spine
Flexibility (turning head)
Thoracic Spine
stability protection of organs
Lumbar Spine
axial loading and movement (lifting objects)
Conditions Treated with TLSO
DJD
DDD
Osteoporosis
Anterior Compression Fractures
Stable Burst Fractures
Post Operative
Osteopenia
loss of bone density commonly seen > 50 YO
Osteoporosis
profound bone loss
bone mineral density greater than 2.5
Anterior Compression Fractures Indications
T4-T9 level stable fractures
sometimes L3-L5
T10-L12 fractures, usually with specific hyperextension TLSO
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
Typical TLSO Anterior Compression Fracture
CF TLSO Corset
CF TLSO sagittal-Coronal, Anterior Coronal or Triplanar body jacket
Stable Burst Fracture
no neurologic injury, subluxation, dislocation
angulation of the spine less than 20 degrees
spinal canal compromise less than 50%
Stable Burst Fracture Treatment Goals
restrict gross spinal motion during healing
reduce loading on fracture
allow mobilization of patient
Stable Burst Fracture TLSO
custom made TLSO- triplanar body jacket
total contact
Flexible
Usually elastic material
spinal belt or wrap
OTC
Semi-Rigid
Flexible but non elastic fabric
metal/plastic stays/panels
Orthopedic corset
custom fitted CF
Rigid
Aluminum or plastic structure
spinal brace
CF or CM
Posterior LSO Fitting Parameters
paraspinal uprights: follow muscle apices
Top: 10 mm inferior to most inferior angle
bottom: sacral coccygeal junction
Lateral LSO Fitting Parameters
Lateral uprights: mid-axillary line
top: clearance at axilla
Bottom: 10 mm trochanteric clearance
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
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
Lateral TLSO Fitting Parameters
Shoulder Straps: deltopectoral groove
Lateral Uprights: mid-axillary line
Top: Clearance at axilla
Bottom: 10 mm trochanteric clearance
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
CF LSO: Sagittal Control
Chairback brace
resists flexion and extension only
canvas or elastic anterior panel
non elastic pelvic strap
lateral uprights
CF LSO: Sagittal Coronal Control
Knight
resists flexion/extension and lateral motion
canvas or elastic anterior panel
non elastic pelvic strap
LSO Posterior Coronal Control
dynamic orthosis resists extension and lateral motion but encourages lumbar flexion
rarely used today
CF TLSO: Sagittal Control
Taylor
higher configuration increases control of upper thoracic spine
canvas or elastic anterior panel
non elastic pelvic strap
CF TLSO: Sagittal Coronal Control
Knight & Taylor
resists flexion/extension and lateral motion
canvas or elastic anterior panel
non-elastic pelvic strap
CF TLSO Tri-planar Control
plastic body jacket
anterior, posterior openings or overlap
low risk applications (CF)
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
Basic Fitting Protocol
- fit supine
- log roll
- locking elbows
- snug closures and verify comfort