Spinal orthosis Department of Rehabilitation Nakornping hospital

References  Delisa JA : Physical medicine and rehabilitation, 4th ed. Williams and Wilkins  Braddom RL : Physical medicines and rehabilitation, 4th ed. Saunder Elsevier  Spinal Orthosis. NYU  Hoppenfeld S : Orthopaedic neurology: a diagnosis guide to neurologic levels,  Philadelphia, Lippincott Williams & Wilkins,  Hsu JD, Michael JW, Fisk JR : AAOS Atlas of orthoses and assistive devices, 4th ed.  Philadelphia

Outline  General basis of spinal orthosis  Classification  CO, CTO, CTLO,TLSO, LSO, SO,CTLSO  Prescription and things to consider

General basis of spinal orthosis  Mechanism of action  Indications  Negative effects

Mechanism of action Increase in intraabdominal pressure Trunk support Reminder >> Limit spinal motion Control of motion Three-point force system Spinal alignment

Trunk support  Reduce vertical loading on T-L spine  Reduce demand of spinal extensor musculature  Increase spine stability

Control of motion  Kinesthetic reminder  Limit intersegmental spinal motion

Spinal alignment  Sagittal control (flexion/extension)  Coronal control (Lt. tilt control)  Transverse control

Indications  Soft tissue injury  Spinal instability  Fracture  Dislocation  Post-op  Spinal deformity

Classification  CO  CTO,CTLO  TLSO  LSO  SO  CTLSO

Cervical orthosis COCTO FlexibleSoft collar Hard collar RigidPhiladephia Miami J Malibu Aspen Newport Halo SOMI TMBJ Yale Four-poster

Philadelphia collar Indication Prehospital trauma immobilization Soft tissue injury Post-op stabilization Post Halo removal Unstable Fx > Surgery > Rigid CTO > Philadelphia

Miami JAspenMalibu

Cervical control FlexionExtensionLateral flexion RotationAxial load S- or SS- F F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

SOMI ( Sterno-Occipital-Mandibular Immobilizer) Function  F-E-R control  Pressure system : control motion and distraction  Provide supine position Indication  Good for bed restricted pt.  Stable spinal injury above C5  Post op. management Flexion control Chest piece connected by uprights (going from ant. to post.) to occipital plate. So, easily applied to supine Removable chin piece so pt. can eat, wash, or shave while lying supine.

Cervical control FlexionExtensionLateral flexion RotationAxial load SS- S F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion Flexion control C1-4 Only !!!

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Don - Doff

Halo Function  F-E-L-R control  Greatest restrict motion (all planes) Indication  Post-op. unstable cervical fracture (esp. occiput-C1)  Post op. management - Rigid metal or graphite ring attached to skull with 4 pins, 4 posters, plastic body vest

Cervical control FlexionExtensionLateral flexion RotationAxial load SSSSS F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

TMBJ (Thermoplastic Minerva Body Jacket) Function  F-E-L-R control, but less restriction of motion compared to Halo vest  Comfort, lighter  Not invasive Indication  Effective in lesion below C2 (occiput-C1 : Halo)  May be preferred orthosis for preschool age children Total contact orthosis with fixation points at chin, Circumferential forehead piece

Cervical control FlexionExtensionLateral flexion RotationAxial load SSSSS F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion ไม่มีในโรงพยาบาลนคร พิงค์

Thoracolumbar orthosis TLSOLSO FlexibleThoraco-lumbosacral corset Lumbosacral corset Lumbar binder RigidTaylor Knight- Taylor Cowhorn Jewett, CASH Chairback Knight Williams

Rigid TLSO : Jewett Brace Function  TLS flexion control  Immobilize lower T & upper L  Single three-point force system Indication  Stable compression fracture of T12-L1  Obesity Ant. hyperextension brace

Jewett control FlexionExtensionLateral flexion RotationAxial load ThoracicSFF or S- LumbarSFF or S- LumbosacralS-FF or S- Flexion control only!!! of T-L spine

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Rigid TLSO : Taylor brace Function  TLS flexion control  Immobilize lower T & upper L  Elevate intraabdominal pressure Indication  Post-op of traumatic fractures,spondylolisthesis. scoliosis, spinal stenosis, HNP, and disk infection  Stable multiple compression fracture of T spine (osteoporosis)

Taylor control FlexionExtensionLateral flexion Rotation ThoracicSSFS- LumbarSSFS- LumbosacralCI FF F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion F-E control of T-L spine

Rigid TLSO : Knight-Taylor brace Function  TLS F-E-L control  Immobilize lower T & upper L Indication  Post-op of traumatic fractures,spondylolisthesis. scoliosis, spinal stenosis, HNP, and disk infection  Stable multiple compression fracture of TL spine

Knight-Taylor control FlexionExtensionLateral flexion Rotation ThoracicSSS-F LumbarSSSS- LumbosacralCI S-

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Rigid LSO : Chairback brace Function  Increase intraabdominal pressure  F-E control Indication  Lower lumbar pathology  Post surgical support

Chairback control FlexionExtensionLateral flexion Rotation LumbarSSS- LumbosacralSSS- F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion F-E only!!!

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Don - Doff

Rigid LSO : Knight brace Function  Increase intraabdominal pressure  F-E-L control Indication  Lower lumbar pathology  Post surgical support Knight brace = chairback brace + Lateral bar

Knight control FlexionExtensionLateral flexion Rotation LumbarSSSS- LumbosacralSSSS- F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

Rigid LSO : William brace Function  Dynamic spinal orthosis  E-L control Indication  Spondylosis  Spondylolisthesis  Not for compression fracture Oblique lateral bar

Willium control FlexionExtensionLateral flexion Rotation LumbarFSSS- LumbosacralFSSS-