Spinal Orthoses Flashcards
Extrinsic Stability
Muscles from back/abdomen
Flexors - Psoas & Abdominals
Extensors - Erector Spinae & Paraspinals
Intrinsic Stability
Ligaments and discs
Ligaments: transfer loads & smooth motion between linkages
Discs: shock absorption
Function of the Orthoses
Immobilize and reduce gross spinal motion
Support or stabilize individual motion segments, reduce planar motion, reduce effects of gravitational axis and loading on vertebral bodies or intervertebral discs
Prevent or correct a deformity (provide neutral alignment)
Functional Rigidity
Flexible, semi-rigid, rigid
Foam Collars
Primarily a kinesthetic reminder
Indicated for soft tissue injuries (whiplash)
Reinforced collars / Soft molded collars
Kinesthetic reminder
Rigid Cervical Orthoses
Philadelphia, Miami J
Extends to manubrium, occipital tuberosities & region above scapular spine.
SOMI
Sterno-Occipital-Mandibular Immobilization
Minerva
Semi rigid anterior (mid-chest to chin) and semi-rigid posterior (mid-dorsum to parietal area of skull)
Padded band that extends & encircles the forehead.
HALO
Provides tri-planar motion control
Halo ring fixed to skull with 4-8 pins, chest jacket & superstructure that connects ring & jacket
Pins do not penetrate the skull. They penetrate scalp, subcutaneous tissue, epicranial aponeurosis & pericranial outer table of compact bone
Thoracic Band
Posterior upper limit ~1” below the inferior angle of the scapulae.
Prevents impingement during arm movement, limits lumbar extension with the pelvic band.
Pelvic Band
Posterior lower limit, as low as possible - to the sacrococcygeal junction + 1/2” clearance when sitting in flat chair.
Paraspinal Bars
Follow apices of paraspinal musculature without contacting the muscle bellies. Structural stability & counterforce to anterior apron.
TLSO - extends to spine of scapulae.
Lateral Uprights
Located midline, attachment for apron & structural integrity. Resist lateral flexion of upper lumbar / lower thoracic.
Abdominal Support/Apron
Below xyphoid process, above symphysis pubis.
As snug as possible.
Thigh Cuff
Attachment to TLSO, LSO to limit gross motion of lower lumbar and pelvis.
LSO/TLSO Components
Thoracic Band
Pelvic Band
Paraspinal Bars
Lateral Uprights
Abdominal Support/Apron
Thigh Cuff
LS Corset with Metal Stays
“flexible” devices
Increase intracavity pressure
Can be effective for pain management
Long-term use can lead to atrophy of musculature
LSO Sagittal Control
Reduces gross motion in sagittal plane
Low back pain, weakness because of arthritis
LSO Sagittal-Coronal Control
Same components as a knight LSO
TLS Corset
Increases leverage of flexible LS corset system.
Posteriorly, added shoulder straps
Mainly a kinesthetic reminder
Hyperextension Orthoses (Jewett/CASH)
Controls just one plane of motion - sagittal.
Limits forward flexion by using three-point pressure system
Jewett Orthosis
Limits flexion/anterior motion following injury to body of vertebrae
Aluminum frame, sternal pad, suprapubic pad, posterior thoracolumbar pad
3-point pressure system
CASH orthosis
Cruciform Anterior Spinal Hyperextension
Often for geriatric patients
Little to no lateral support
Limits spinal extension (spondylolisthesis)
Body Jackets (LSO/TLSO)
Plastic Shell
Prefabricated or custom made to model of patient
Anterior overlap or bivalve openings
Anterior or posterior openings for lateral curvature of the spine.
LSO Trim Lines
Ant Sup: @ / just below xyphoid
Ant Inf: Superior to symphysis pubis
Post Sup: 24mm inferior to inferior angle of the scapula
Post Inf: @ SC junction or apex of gluteal mass
(Typically extend apex to g-fold when user has spinal involvement of lower lumbar region)
TLSO Trim Lines
Ant Sup: inferior to sternal notch
Ant Inf: Superior to symphysis pubis
Post Sup: inferior aspect of spine of scapula
Post Inf: @ SC junction or apex of gluteal mass
(Typically extend apex to g-fold when user has spinal involvement of lower lumbar region)
Negative effects of Spinal Orthoses
Muscle atrophy, joint contracture, hypermobility, respiratory difficulties, poor appearance, noncompliant users
Wearing schedule
Gradual acclimation to full time wear
immediate wear vs. occasional wear
