Spinal Orthoses

Question 1

In infants with IS in which the curve is less than 25 degrees, should bracing be required?

Answer 1

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.

Question 2

When is a Milwaukee brace indicated?

Name the components and subsequent principles.

Answer 2

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

Question 3

What should a brace to treat scheurmann’s kyphosis look like?

Answer 3

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.

Question 4

Reducing lumbar lordosis in the cast is important when treating scheurmann’s kyphosis?

Answer 4

true

Question 5

When is a Knight style brace appropriate?

Answer 5

LSO

Sagittal and coronal plane control in the lumbar region.

similar to chair back but with lateral bars to prevent side bending.

Question 6

When is a custom fabricated body jacket appropriate?

Answer 6

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.

Question 7

What’s the most common curve type in juvenile (3-10) IS.

Answer 7

convex right thoracic curves. Most likely to require surgical stabilization.

Question 8

What are the trim lines for an LSO?

Answer 8

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.

Question 9

What can you add to a TLSO to improve control at sites T3 and higher.

Answer 9

Over the shoulder straps

Question 10

What’s the minimum amount of wear time a scoliosis patient must be in their brace for it to be effective.

Answer 10

20 hours. preferably 23.

Question 11

When is a williams flexion brace appropriate?

Answer 11

LSO

When extension and side bending is unwanted, but flexion is allowed.

example: spondylolisthesis.

Question 12

Scoliosis is a three plane deformity ? T/F

Answer 12

true

*spinous process will favor towards the side of concavity.

Question 13

How long is the treatment period for bracing of scheurmann’s kyphosis?

Answer 13

12-18 months with radiographs every 3-4 months.

Question 14

True or false. The orthosis will generally improve the amount of deformity to a significant degree after treatment is complete.

Answer 14

False. Likely just prevents progression.

Question 15

When is a knight taylor brace appropriate?

Answer 15

TLSO

When flexion, extension, and lateral bending of the thoracolumbar spine is unwanted.

Question 16

When is a Jewett or CASH brace appropriate?

Answer 16

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.

Question 17

Which curves are least likely to progress and are most receptive to brace treatment?

Answer 17

single lumbar and thoracolumbar curves.

Question 18

What kind of brace could you use for a compression fracture

Answer 18

Jewett Hyperextension TLSO. or CASH

Question 19

What kind of exercises would one recommend to individuals who have scheurmann’s kyphosis?

Answer 19

Programs to strengthen spinal extensors and abdominal muscles (to reduce lumbar hyperlordosis).

Question 20

When should adolescents with IS be prescribed a brace.

Answer 20

Risser greater or less than 2, with curves greater than 25, but less than 45.

Pre menarche or less than 1 year post menarche.

Question 21

When are TLSOs indicated for treatment

Answer 21

For treatment of curves with apices at or below T8.

Question 22

What kind of brace would you use for a burst fracture?

Answer 22

TLSO. hyperextension brace does not provide adequate triplanar control required. Particularly in the transverse plane.

Question 23

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?)

Answer 23

True

Question 24

When is a Chairback style brace appropriate?

Answer 24

LSO

indicated for flexion extension control in the lumbar region

Question 25

What sagittal alignment should the brace be cast or fabricated in for best management of scoliosis.

Answer 25

Decreased lordosis fo the lumbar spine (flexed at the hips), to reduce hypokyphosis in thoracic scoliosis patients.

Question 26

When is a Taylor style brace appropriate?

Answer 26

TLSO

When extension is unwanted and flexion needs to be limited to a certain degree.

Question 27

What’s the normal range of thoracic kyphosis

Answer 27

20-45 degrees

Question 28

What level is a hangman’s fracture and what is the mechanism of injury?

Answer 28

C2, hyperextension and distraction.

Question 29

Which type of odontoid features are considered unstable?

Answer 29

II and III

Question 30

What level is a Jefferson fracture? is this stable or unstable?

Answer 30

C1 unstable

Usually requires HALO