L4 Spinal Orthotics Flashcards
Goals of Spinal Orthoses
- limit motion to reduce pain, protect unstable segments, or facilitate healing following injury/surgery
- support the trunk or neck to reduce loads applied to spine during functional activities
- Correct or limit the progression of deformity
- provide a reminder to the wearer to maintain or initiate active postural corrections
- alignment of spinal skeletal structures
- reduction of axial loading through spine
- increasing intra-abdominal pressure may reduce axial loading
Spinal orthoses DO NOT
apply forces to assist movement or substitute for missing muscle function
Cervical Orthoses
support spine’s muscular and bony structures
soft or hard, depends on if you want to restrict or allow movement
Cervical orthoses are used for
control of unwanted cervical flexion, extension, rotation
after trauma, acute pain, spinal stenosis
Soft Cervical Collar
soft foam material with velcro strap
cannot significantly restrict cervical spine ROM
provides partial support of head reducing para-spinal contraction and spasm
recommended use less than 2 weeks
Uses of soft cervical collar
used to manage muscle pain and spasms such as spondylosis, minor trauma like whiplash
Hard Cervical Collars
rigid or semi rigid
main function is support, limits motion in all planesT
types of hard cervical collar
miami j collar
VISTA collar
aspen
headmaster
philadelphia
Indications for hard cervical collars
- cervical trauma in unconscious pt
- jefferson’s fracture
- traumatic spondyloisthesis of C2 on C3
- dens type 1 fracture
- post-op care
- anterior discectomy
- cervical strain
Philadelphia Collar
greater ability to limit movement compared to the soft collar
large hole in the front is designed to accommodate a tracheostomy. also used for postsurgical stabilization
provides slight load reduction
Cervicothoracic Orthosis Types
halo
sterno-occipital mandibular orthosis
minerva
Halo
-surgically applied by pins which are placed in cranial table with jacket fitted to torso
-more effective than hard collar at restricting motion
Indications for Halo
presurgical correction
post op fusion support
alternative to surgery
Minerva
removable version of the halo
offers control of motion down to T3
Indications of Minerva
-mid to lower cervical spine injuries
-stable upper cervical spine injuries
-can be used with skull fractures when a halo would be contraindicated
-peds due to decreased weight/improved comfort
Cervico-thoracolumbosacral orthosis CTLSO
post-operative cervical fusions
a/p control of cervical spine
high compression fractures
osteoporosis
herniated cervical disc
spinal trauma
Thoracolumbosacral orthosis
Off the shelf = cash, jewett
custom molded
TLSO Indications
post op fusion
kyphosis
compression fx
osteoporosis
burst fx
spinal stenosis
spinal muscular atrophy
laminectomy
spinal trauma
CASH Brace
used for cruciform anterior spinal HE
provides flexion control for the lowe rthoracic and lumbar regions via the three point pressure system
Forces of CASH Brace
post directed forces through sternal and suprapubic pads
anteriorly directed force applied through a thoracolumbar pad
Jewett Orthosis
limits spinal flexion
reduces discomfort associated with compression fx, degenerative disc disease, kyphosis, osteoporosis, OA
Indications for bracing in scoliosis
flexible curves with cobb’s angle 10-40°
> 40° indicates surgery
30-40° use of orthosis
10-20° observe
Orthopedists typically recommend bracing for scoliosis for peds..
who are still growing and have a curvature ≥ 25°
Goal of scoliosis brace
its to keep the curve from progressing to the level taht surgery is required
some pts achieve curve reduction with bracing
Boston brace
3 point pressure system
cuts outs to allow body to move
difficult to control rotation
Cheneau Brace
relatively new with limited research
fully custom made
controls rotation with extension at shoulders
Indications of LSO
post op
degenerative disc disease
spondyloysis
spinal stenosis
compression fx
herniated disc
pain relief
postural support
reduces lumbar lordosis
vasomotor and respiratory support
increases abdominal pressure
Types of LSO
soft fabric lumbar support
molded plastic
Post surgical spinal orthoses
surgeon post op orders specify wear time, how to wear, etc
logroll technique technique to don brace in bad
Spinal fusion
should be wearing spinal orthosis for up to 3 months
dictated by surgeons preference
