Orthotic management of Spinal Trauma

Question 1

Principles of Orthotic management of Spinal Trauma

Answer 1

1. Orthosis can manage “clinically stable” fractures
2. Orthosis can manage selected multi-column fractures
3. Orthotic goal = increase tri-planar stability while healing
4. Understanding mechanism of injury may be useful

Question 2

Selected multi-column fractures that can be orthotically managed

Answer 2

• upper cervical fractures with Halo-Vest CTO
• TL Burst fractures with custom TLSO Body Jackets
• Lumbar Lap Belt fractures with custom TLSO Body Jackets

Question 3

Post-Op TLSO Body Jacket

Answer 3

• facilitates early mobilization for faster recovery
• routine use decreasing as surgery improves
• obesity decreases orthotic control & effectiveness

Question 4

Modify TLSO Design based on location of fx/constructs

*

Answer 4

• T2 and higer = consider CTO instead, add semi-rigid CO extension
• T3 or higher = consider adding Over Shoulder Straps to stiffen proximal TLSO
• L4 or lower = consider adding thigh extension on at least one side

Question 5

Primary Orthotic Goals of Non-Operative TLSO Body Jacket

Answer 5

• provide proper alignment to foster healing
• limit gross motion of spinal column
• reduce intersegmental movement at sites of injury

Question 6

C1 Jefferson Fracture management

Axial Load

Answer 6

• Stable: Semi-rigid CO collar
• Unstable: Halo, minnerva, traction, surgery

Question 7

C2 Odontoid Fracture Management

Shear + Compression

Answer 7

• Stable (type I): Semi-rigid CO
• Unstable (Type II & III): Halo-vest, traction, surgery

Question 8

C2 Hangman’s Fracture Management

Hyperextension & Distraction

Answer 8

• Stable (Type I): Semi-rigid CO, CTO
• Unstable (Type II): Halo, Minnerva
• Unstable (type III): Surgery

Question 9

C3-C7 Anterior Compression Fracture Management

Hyperflexion

Answer 9

• Stable: semi-rigid CO
• Unstable: Halo-vest, traction, surgery

Question 10

C3-C7 Whiplash Management

soft tissue only

Answer 10

Stable: Soft CO

Question 11

T1-T8 Anterior Compression Denis I Management

Flexion + Compression

Answer 11

• Mild: Corset
• Moderate: Hyperextension orthosis such as jewett
• Severe: TLSO

Question 12

T1-T8 Burst Denis II Management

Compression + Flexion

Answer 12

Stable: Custom TLSO Body jacket

Question 13

T9-T12 Boney Chance Denis III Management

Answer 13

• usually custom body jacket if considered stable
• unstable: Surgery

Question 14

L1-L2 Anterior Compression Denis I Management

Flexion + Compression

Answer 14

• Mild: Corset
• Moderate: Hyperextension orthosis such as jewett
• Severe: TLSO

Question 15

L3-L5 Spondylolysis Management

Answer 15

• Mild: Corset
• Moderate: CF LSO/TLSO