Spinal Orthoses Flashcards
Halo Thoracic Vest (HTV)
Level C1-T3
C spine
High T spine
Multi-Level
With or without fracture
Operative or non operative
Complex spinal surgery
Unstable fracture
Most rigid fixation for maximum stability during healing process (6-12 weeks)
Patient may experience difficultly swallowing
Minerva
Level Occiput-T5
C-spine
High T-spine
Multi-level
With or without fracture
Non Operative Management
Encloses entire posterior skull, includes band around forehead
Management of unstable cervical spine
Post operative when spine still considered to be unstable
Post fusion
Patient with tracheal tube
Forehead band provides control of all cervical motions (however less restriction compared to halo)
Long term wearer (6-8 months, removable liner, durable)
Lighter than halo, no pins, no risks associated with pins (infection etc.)
Contraindication of Halo
Scalp injuries
Fixation not possible
SOMI (Sternal Occipital Mandibular Immobilizer)
Level C1-T1
C-spine
High T-spine
Multi-level
Operative and non operative management
Post operative spine still considered to be unstable
Also cervical arthritis
Usually used when Upper C-spine (C1-C4) requires support
Chest piece connected by uprights (going anterior to posterior) to occipital plate
Removable mandibular piece (allow eat, wash etc.)
More stability provided in flexion-extension than Guilford
Presence of mass around neck or shorter neck
Guilford
Level C1-C7
C spine
With or without fracture
Operative or non-operative management
Post operative when injury still considered unstable
Temporary support post HTV
Can be modified for tracheal tube
Typically used for lower C-spine (C4-C7)
Conta-indicated when presence of back injury due to posterior pad
Philadelphia
Level C1-C7
Best C6-T2
C-spine
With or without fracture
Operative or non operative
Post operative Post HTV - limit sudden strain on neck after prolonged immobilization Patients with tracheal tube Soft tissue injuries STABLE bony or ligamentous injuries
Used when injury considered stable, surgical fixation not required
Limits extremes in neck movement
Provides moderated amount of movement restriction and head support
Encompasses lower jaw and occiput and extends to proximal thorax
Made of Plastazote, rigid anterior and posterior Kydex palstic reinforcements, velcro closures
Soft Collar
Level C1-C7
Provides no significant control of motion of the cervical spine
Does provide kinesthetic reminder (through sensory feedback) to limit motion, maintain neutral position
Visual reminder that patient requires extra consideration in approach to their care
Retains body heat (which may help reduce muscle spasm and aid in healing of soft tissue injuries)
Provides comfort (may be due in part to 1 and 2)
Used primarily for soft tissue injuries of the neck (i.e. whiplash injury)
Jewett
Level T7-L2
Mid to Lower T spine
Upper L spine
Multi-level injuries
May be used post surgery
Hyperextension orthosis
Prevents flexion after compression fracture of the thoracolumbar spine
Also used for thoracolumbar Scheuermann’s disease, thoracic osteoporotic kyphosis
Consists of sternal pad, suprapubic pad, anterolateral pads connected by oblique lateral uprights counteracted by dorsolumbar pad
Harris-Knight
Level L2-L5
L spine injuries
Used post operatively
Hip spica may be added to increase immobilization of L5-S1
Restriction of hip flexion to 90 degrees
Where fracture and or fusion involves, L2-L3, L3 vertebra lower hip flexion precautions may apply
L1-L2, L2 restrictions should be clarified by physician
Duration and frequency of sitting may need to be clarified
Reverse Harris-Knight
Level T7-S1
Only used when COMBINATION of T-spine and L-spine injuries
Restriction of hip flexion to 90 degrees
Where fracture and or fusion involves, L2-L3, L3 vertebra lower hip flexion precautions may apply
L1-L2, L2 restrictions should be clarified by physician
Duration and frequency of sitting may need to be clarified
Taylor-Harris
Level T7-S1
Only used when COMBINATION of T-spine and L-spine injuries
Shoulder straps and extensions give brace postural support to T-spine, promote scapular retraction to reduce upper T-spine kyphosis where T-spine injury present
Used post-operatively
Restriction of hip flexion to 90 degrees
Where fracture and or fusion involves, L2-L3, L3 vertebra lower hip flexion precautions may apply
L1-L2, L2 restrictions should be clarified by physician
Duration and frequency of sitting may need to be clarified
Custom Spinal
T1-S1
COMBINATION of T spine and L spine
Used with max stability is required during healing process
Post op concern injury is still unstable
Many levels of unstable fractures or ligamentous injury present
Comprised of 2 portions
Molded posterior and anterior jewett
Restriction of hip flexion to 90 degrees
Where fracture and or fusion involves, L2-L3, L3 vertebra lower hip flexion precautions may apply
L1-L2, L2 restrictions should be clarified by physician
Duration and frequency of sitting may need to be clarified
Clam Shell
Level T1-S1
T spine
L spine
Multi levels
With or without fracture
Operative or non operative
SCOLIOSIS OR KYPHOSIS CORRECTION
Max stability during healing
Post op concerns injury still unstable
Presence of ligamentous injury
Consists of molded anterior and posterior portions
Restriction of hip flexion to 90 degrees
Where fracture and or fusion involves, L2-L3, L3 vertebra lower hip flexion precautions may apply
L1-L2, L2 restrictions should be clarified by physician
Duration and frequency of sitting may need to be clarified
Body Cast
Level T1-S1
T Spine
L Spine
Multi level injuries
With or without fracture
Operative or non operative
Elective scoliosis or kyphosis correction
Maximum stability during healing
Post operative spine considered unstable
Multi level injuries
Inability to afford orthosis
Compliance is an issue
Patient may experience some difficulty breathing
Hip spica may be added to increase L5-S1 immobilization
Restriction of hip flexion to 90 degrees
Where fracture and or fusion involves, L2-L3, L3 vertebra lower hip flexion precautions may apply
L1-L2, L2 restrictions should be clarified by physician
Duration and frequency of sitting may need to be clarified
