Types of orthosis use for spine deformities

Question 1

Types of orthosis use for spine deformities

Answer 1

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Question 2

Cervicothoracolumbosacral Orthoses ( 2 )

Answer 2

Milwaukee Orthosis

Thoracolumbosacral Low-Profile

Question 3

Type: Milwaukee Orthosis

Answer 3

Biomechanics
x The Milwaukee orthosis is used for scoliosis management. It provides control of flexion, extension, and lateral bending of the cervical, thoracic, and lumber spine. It also provides some rotational control of the thoracic and lumbar spine. Pressure systems are used for control of motion, as well as to provide correction for the spine. The Milwaukee is a good choice for patients who need correction in the higher thoracic region of the spine.
Design and Fabrication
x The Milwaukee is custom made, consisting of a cervical portion with the option of a removable cervical ring. Also used is the thoracolumbar section of the orthosis in which the correction of the lower thoracic and lumbar spines is achieved.
Indications
x The Milwaukee brace is used primarily for scoliotic management of the high thoracic curves along with thoracic and lumbar curves of the spine.

Contraindications
x This orthosis is not indicated for lower thoracic and lumbar curves only. With lower thoracic and lumbar curves a thoracolumbar orthosis could be used without the use of the cervical component.

Question 4

Thoracolumbosacral Low-Profile

Answer 4

Scoliosis Orthoses

Boston Brace, Miami Orthosis ,Wilmington Brace

Biomechanics
x The TLSO low-profile scoliosis orthoses provide dynamic action using three principles (end- point control, transverse loading, and curve correction) to prevent curve progression and to stabilize the spine.

Design and Fabrication
x The effective non-operative treatment of idiopathic scoliosis using a low-profile TLSO has been demonstrated over the past 30 years. The most common of these orthoses is the Boston brace, introduced by Hall and Miller10 in 1975. This system is available in prefabricated modules that are available in 30 sizes and can be ordered by measurement; they are then custom-fit to the patient. Modules can be used to fit approximately 85% of patients. Six of these sizes will fit approximately 60% of patients requiring an orthosis. The orthosis can also be custom-fabricated from a mold of the patient‘s body. Trim lines are established based on the patient‘s curve; they are designed to provide pressure in specified areas to maximize corrective forces, and at the same time be less visible under the patient‘s clothing.

Indications
x This orthosis is indicated in patients with an immature skeleton and documented progression of a thoracic or thoracolumbar idiopathic scoliosis that measures 25 to 35 degrees (measured by the Cobb method) and has an apex of T7 or lower.

Contraindications
x The orthosis is contraindicated in patients with curves that measure greater than 40 degrees and who are skeletally immature, or with curves in excess of 50 degrees after the end of growth. Both of these types of patients are typically candidates for surgery.

Operative procedures
 Surgical goals are to halt progression of the curvature, improve alignment, decrease deformity, prevent pulmonary problems, and eliminate pain.
 Surgical intervention (e.g., fusion with posterior segmental spinal instrumentation) may be necessary for curvatures greater than 45 degrees, in the presence of chronic pain, or when the curvature appears to be causing neurologic changes.
 Surgical options include a variety of segmental instrumentation systems including Luque, Cotrel-Dubousset, and unit rod instrumentation and Harrington rods. These are combined with a posterior fusion and, in more severe cases, anterior fusion.