Spinal Orthoses Flashcards
Purpose of spinal orthoses
- Limit motion of a spinal region
- Decrease stress applied to region treated
- Prevent deformity
- Post operation
- LBP exacerbation
What is the general role of spinal orthoses
- To limit the motion of a spinal region, decreasing the amount of load applied to the region treated
Slide 4
How do braces work
- 3 point pressure system: 3 points of applied force, one posteriorly & 2 anteriorly
- Circumferential support
Classification of spinal orthoses
- Rigid (most control)
- Semirigid/combination
- Flexible (least control)
- Can be named after the creator of the brace: Knight Taylor, Jewitt Brace
Indications for use of a rigid/semi rigid brace
- Status post anterior cervical fusion: very much physician guided, trend is moving towards NOT bracing
- Jefferson’s Fracture: C1
- Hangman’s fracture traumatic spondylolisthesis of C2 on C3
- Dens type I fracture of anterior diskectomy
- Cervical trauma in unconscious patients
- Cervical strain
Describe soft collars
- Provide partial support of the head reducing paraspinal contraction & spasm
- True benefit is warmth, psychological reassurance & a kinesthetic reminder to limit motion
- Problem is that it gives no true structural cervical spine support
Describe the headmaster control
- Limited control
- Low profile
- Used to support the head
Why is the cervicothoracic area challenging to immobilize
- It is a transitional area between the very mobile & lordotic cervical spine & the kyphotic thoracic spine
Describe cervicothoracic orthoses
- Provide maximal control of flexion, extension, & rotation of the cervical spine
- Can be used for conditions extending as far caudally of T5
- Increasing the length of the orthoses down the trunk enhances its capabilities
Indications for a cervicothoracic orthoses
- Atlanto-axial instability such as in RA neural arch fractures of C2 due to flexion instability
What orthoses is often used as a possible replacement to the Halo
- Minerva brace
Describe the Halo Vest
- Best at restricting motion
- If needs to immobilize the occipitocervical spine fixation to the skull is required
- 6-8 transcranial pins provide secure proximal fixation & full contact support around the thorax & torso provide the distal fixation
- Results in maximal triplantar control
- Complications can include pressure sores, loss of reduction, & pin infection & loosening
Rehab considerations with a Halo
- Rehab can be challenging due to altered center of mass
- Fixed head position alters ability to use visual cues
- May have forward head posture when ambulating, to accommodate use a cane/walker
- readjustment period following Halo removal that may require postural reeducation as part of the rehab strategy
- Poor cervical spine dissociatioon
From most to least which cervical motions are limited due to bracing
- Flexion/extension
- Lateral bending
- Rotation
Describe thoracolumbar orthoses
- Most common region affected by traumatic fracture & most likely to benefit from orthotic support
- Compression Fx are common & Tx varies from kyphoplasty, vertebroplasty, or conservative bracing
- Best used for Fx from T10-L2
- Goal”: prevent excessive anterior flex & development of kyphotic deformity
- Contraindicated for 3 column instability
Contraindications for thoracolumbar orthoses
- Unstable 3 column vertebral fractures
- Compression fractures above T6 for there is increased motion above the pad
- Where extension is prohibited for it can cause excessive hyperextension forces on the posterior elements
Decreasing ____________ reduces compressive forces on the fractured vertebral body 7 limited distraction oof the posterior elements
- Flexion
Describe TLSO braces
- Used to manage Fx or post surgical pts with T6-L4 involvement
- Restrict motions in all planes
- Straps over the shoulders may provide additional stability to the brace
- Bi-valved or clamshell to allow for donning & doffing
Describe LSO braces
- Difficult too effectively brace due too extensive ROM of the flexion-extension motion of the spine
- Common for post L2-4 spinal surgery for with non-op back pain
- Recent surgical advances now limit the prescription of these
- Mostly used now for comfort for those pt’s with poor bone quality
- Conflicting results when using corsets to manage acute LBP, conflicting evidence of reconditioning effect
Describe a flexible LSO
- Essentially for kinesthetic awareness, pain relief, reduce excessive lumbar lordosis, vasomotor & respiratory su[port in SCI patients
Describe a rigid LSO
- More stability
- Can create increased intra-abdominal pressure that will improve stability of the spine
- Concerns for reconditioning with long term use
Describe SI support braces (SIOs)
- Worn around the pelvis b/w he iliac cress & the greater trochanters
- Used by patients with back pain that is attributed to SI joint hypo or hyper mobility
- Used in conjunction with manipulation or spinal stabilization exercises
- Use of a SI belt with pregnant pts may decrease SIJ mobility & reduce pain syndrome during functional actitivites
Potential issues with spinal orthoses
- Poor compliance
- Body habitus
- Proper fit and function
- Dependency
- Skin breakdown
- Financial burden
- Alterations to the movement system: contracture, weakness, pain, balance strategies, ROM