Spinal Orthoses Flashcards
In infants with IS in which the curve is less than 25 degrees, should bracing be required?
No. Only close monitoring is needed. However, if progression of the curve is demonstrated, serial casting proves to be the most effective followed by TLSO wear, for 6 months.
When is a Milwaukee brace indicated?
Name the components and subsequent principles.
TLSO
Scoliosis treatment.
Thoracic pad- L shaped pad used on convex side of the curve at the rib of the apical vertebrae and below. Placed posterior laterally to drive anterior derotational force.
Lumbar pad- triangular pad inferior to the coastal ribs and superior to the iliac crest. Directly over curve apex on the convex side, in a similar posterior lateral placement to that of the thoracic pad.
Pad pressure- Maximum tolerable!
*All TLSOs use same pad placement as Milwaukee
What should a brace to treat scheurmann’s kyphosis look like?
TLSO or Milwaukee
Pelvic girdle should lock into pelvis without impinging crest, decrease lumbar lordosis, and waist grooves that prevent superior/inferior migration.
poster pad at the apex of the curve and just inferior.
Neck ring or sternal pad provides a posteriorly directed counterforce to the pad.
Reducing lumbar lordosis in the cast is important when treating scheurmann’s kyphosis?
true
When is a Knight style brace appropriate?
LSO
Sagittal and coronal plane control in the lumbar region.
similar to chair back but with lateral bars to prevent side bending.
When is a custom fabricated body jacket appropriate?
TLSO
When triplanar control is required.
bivalve design for patients with variable volume
anterior opening design easier to don, so this is more suitable for non surgical patients.
What’s the most common curve type in juvenile (3-10) IS.
convex right thoracic curves. Most likely to require surgical stabilization.
What are the trim lines for an LSO?
Anteriorly: just below xiphoid process, above the pubic symphysis .
Posteriorly: just below inferior angle of the scapula and just below apex of gluteal bulge for men, gluteal fold for women.
What can you add to a TLSO to improve control at sites T3 and higher.
Over the shoulder straps
What’s the minimum amount of wear time a scoliosis patient must be in their brace for it to be effective.
20 hours. preferably 23.
When is a williams flexion brace appropriate?
LSO
When extension and side bending is unwanted, but flexion is allowed.
example: spondylolisthesis.
Scoliosis is a three plane deformity ? T/F
true
*spinous process will favor towards the side of concavity.
How long is the treatment period for bracing of scheurmann’s kyphosis?
12-18 months with radiographs every 3-4 months.
True or false. The orthosis will generally improve the amount of deformity to a significant degree after treatment is complete.
False. Likely just prevents progression.
When is a knight taylor brace appropriate?
TLSO
When flexion, extension, and lateral bending of the thoracolumbar spine is unwanted.
When is a Jewett or CASH brace appropriate?
TLSO
When restriction of flexion is wanted is wanted.
example: anterior compression fractures.
Note: CASH used for older patient populations due to ease of donning.
Which curves are least likely to progress and are most receptive to brace treatment?
single lumbar and thoracolumbar curves.
What kind of brace could you use for a compression fracture
Jewett Hyperextension TLSO. or CASH
What kind of exercises would one recommend to individuals who have scheurmann’s kyphosis?
Programs to strengthen spinal extensors and abdominal muscles (to reduce lumbar hyperlordosis).
When should adolescents with IS be prescribed a brace.
Risser greater or less than 2, with curves greater than 25, but less than 45.
Pre menarche or less than 1 year post menarche.
When are TLSOs indicated for treatment
For treatment of curves with apices at or below T8.
What kind of brace would you use for a burst fracture?
TLSO. hyperextension brace does not provide adequate triplanar control required. Particularly in the transverse plane.
T/F multiple curves with differential stiffnesses can be treated with differential loads, whereas curves with equal stiffness should be loaded relatively equally (Double major curves?)
True
When is a Chairback style brace appropriate?
LSO
indicated for flexion extension control in the lumbar region
What sagittal alignment should the brace be cast or fabricated in for best management of scoliosis.
Decreased lordosis fo the lumbar spine (flexed at the hips), to reduce hypokyphosis in thoracic scoliosis patients.
When is a Taylor style brace appropriate?
TLSO
When extension is unwanted and flexion needs to be limited to a certain degree.
What’s the normal range of thoracic kyphosis
20-45 degrees
What level is a hangman’s fracture and what is the mechanism of injury?
C2, hyperextension and distraction.
Which type of odontoid features are considered unstable?
II and III
What level is a Jefferson fracture? is this stable or unstable?
C1 unstable
Usually requires HALO
