Spinal Orthosis

Biomechanical functions of spinal orthosis

1. Kinesthetic reminder: psychological cuing correct the deformity (for flexible deformity).
2. Offer total contact: contact is direct proportional to the pressure distribution and control.
3. Three-point pressure correction
4. End-point control: complete end to end control / grasp from cephalad to caudal point of interest.
5. Elevated pressure: the net force applied to the spine during the act of lifting a weight from the floor.
(1) Elevated intra-abdominal pressure may reduce some of the stress placed on the spine itself.
(2) There is increase of pressure in abdominal area.
Functions of spinal orthosis
1. Stabilization (immobilization).
2. Function
3. Correction
4. Prevention
5. Protection
Cervical orthosis
Introduction
1. Prefabricated cervical orthoses: collars, post-appliance
2. Custom-made (kinesthetic limitation)
Collar
1. Motion restriction is minimal (flexion extension limitation)
2. Serve as a kinesthetic reminder to limit neck movement.
3. Material used: resilient polyethylene foam, sponge rubber and felt, as well as rigid polyethylene sheeting.
Soft collar
1. Lightweight material (absorbent).
2. Soiled easily with long-term use.
3. Common material: polyurethane foam rubber.
4. It limits the
(1) Full flexion / extension at least 15%.
(2) Full lateral bending 5 – 10%.
(3) Full rotation 10 – 17%.
5. Benefits:
(1) Warmth, psychological comfort.
(2) Support to the head during acute neck pain.
(3) Relief with minor muscle spasm associated with spondylolysis.
(4) Relief in cervical strains.
6. Not for severe neck injuries such as cervical vertebral fracture.
Hard collar
1. More durable and rigid than soft collar.
2. It limits:
(1) Full flexion / extension by 20%.
(2) Less effective in the restricting lateral bending and rotation.
3. Indications:
(1) Prehospital trauma immobilization.
(2) Long-term management in patients who sustained a cervical injury.
Philadelphia collar
1. Provide some control of flexion, extension and lateral bending, and minimal rotation control of the
cervical region (greater restriction compared to basic collars).
2. Terminates superiorly over the mandible and at the occiput, lower at proximal thorax area.
3. Made of Plastazone / polyethylene foam, 2 separate pieces.
4. Indications
(1) Cervical sprain / strains.
(2) Stable fracture.
(3) Protection.
(4) Limit mobility after surgery.
(5) Medical emergency.
5. Contraindications:
(1) Unstable fracture.
Cervical thoracic orthosis (CTO)
 General consideration of cervical orthosis
1. Provide greater motion restriction in the middle to lower cervical spine from the added pressure on the
body.
2. CTOs are used in minimally stable fractures.
3. All orthotics tend to control flexion better than extension.
Four poster adjustable orthoses (Lido cervical collar)
1. Design
(1) A rigid orthosis with anterior and posterior chest pads.
(2) Uses shoulder straps, but it has no underarm support.
2. Functions:
(1) Slightly better at controlling lateral bending compared to the cervicothoracic brace in the cervical spine.
(2) Also effective for controlling flexion in the mid-cervical segments.
Sterno-oocipital-mandibular-immobilizer (S.O.M.I.) brace
1. Consisting of
(1) Anterior and posterior sections of pads lie on the chest
(2) Removable chin plate for eating.
(3) Uprights which maintain the position of the occipital support arise anteriorly from sternal plate.
2. Ideal for bedridden.
3. Effective in controlling flexion at C1 – C5 segment.
4. Indication:
(1) Cervical sprains / strains.
(2) Stable fracture with intact ligaments
(3) Protection
(4) Limit mobility.
5. Contraindication:
 (1) Immobilization in atlanto-axial instability due to RA.
(2) immobilization for neural arch fracture of C2 sine flexion cause instability.
(3) Unstable fractures with ligament instability.
Halo orthosis
1. Designed & fabrication
(1) Consists of prefabricated components such as halo ring, pins, uprights and vest.
(2) The halo ring is fixed to the outer table of the skull bones with generally four or mote metal pins.
(3) Uprights bars connect the ring to a rigid plastic thoracic vest.
2. The design is used to effectively immobilize the cervical spine (maximum restriction in motion).
3. With invasion and non-invasion.
4. Indication: the halo is generally used for instable cervical fractures or postoperative management.
5. Contraindications:
(1) Concomitant skull fracture with cervical injury.
(2) Damaged or infected skin over pin insertion sites.
(3) Cervical instability with ligamentous disruption.
Rigid Spinal Orthosis: Components
1. Pelvic band
(1) Lateral ends lie midway between the greater trochanter and the iliac crests and mid-trochanteric line.
(2) Posteriorly, the middle section lies above the inferior edge of the sacrum below the PSIS.
2. Thoracic band
(1) Superior border: T7, T8 (cover the inferior angle).
(2) lateral end: lateral midline of the rib cage.
3. Lateral uprights
(1) Superior end: superior end of the thoracic band.
(2) Inferior end: inferior edge of the pelvic band (GT 上約 1 寸半).
(3) Prevent lateral flexion.
4. Paraspinal uprights
(1) Superior ends:
- LS: in below IAS.
- TLS: lateral aspect of the scapular spines.
(2) Inferior ends: postmidline of the inferior edge of the pelvic band.
(3) bulges of the paraspinal muscles (covers transversus process).
5. Abdominal support or Apron
(1) Superior: Below xiphoid process when seated.
(2) Inferior: Above symphysis pubis with inferior border roughly follows the inguinal folds.
(3) Pelvic strap: Attached to the pelvic band, passes inferior to ASIS
(4) Waist strap:
- Loop around the posterior upright
- Between the iliac crest and rib cage.
(5) Thoracic strap: Attached to each ends of the thoracic band.
(6) Additional strap: used if the patient is tall to avoid wrinkling of the abdominal support.
(7) Corset front: attached to the lateral uprights by laces.
Lumbosacral orthosis (LSO)
Chair back (Rigid short LSO)
1. Design:
(1) Lumbosacral posterior uprights attached inferiorly to the pelvic band and superiorly to a thoracic band.
(2) Abdominal apron has straps for adjustment.
(3) No lateral uprights.
2. Functions:
(1) Provides elevation of intraabdominal pressure.
(2) Restricting trunk flexion, extension.
3. Indications:
(1) Relief for low back pain.
(2) Immobilization after lumbar laminectomy, fusions or diskectomies.
(3) Degenerative disc disease.
Knight brace
1. Same with chairback but with additional lateral uprights.
2. More effective since the pelvic and thoracic bands are anchored by lateral uprights.
Williams brace
1. Design:
(1) Pelvic and thoracic bands joined lateral upright.
(2) Pelvic band is stabilized by oblique lateral uprights.
(3) Abdominal pads.
2. Functions:
(1) Restrict extension.
(2) Restricts lateral trunk motion.
3. Indications: decreasing hyperlordosis.
Plastic body jacket
1. Provide maximum orthotic immobilization and control of the spine.
2. Total body contact expect or bony prominences.
3. Restricts all motions of the trunk.
Thoraco-Lumbar Orthosis (TLO)
Introduction
1. used mainly to treatment fractures from T10 – L2 since their mobility is nor restricted by the ribs.
2. Immobilization of T10 – L2 helps prevent further collapse.
Boston brace
1. For thoracic curve below T8.
- Provide dynamic action using three principles (end-point control, transverse loading, and curve
correction) to prevent curve progression and to stabilize the spine.
2. Posterior opening plastic module which encompasses the pelvis and thorax.
3. With perforations to alleviate potential skin irritation.
4. For the treatment of Adolescent Idiopathic Scoliosis & Juvenile idiopathic scoliosis – occurs in children
between the ages of 3 to 10.
Jewett hyperextension brace
1. Designs
(1) Uses a 3-point pressure system.
(2) The 2 anterior pads place pressure over the sternum and pubic symphysis.
(3) The 1 posterior pad places opposing pressure in the mid-thoracic region.
(4) No abdominal support is provided with this device.
2. Motion restriction
(1) Limits flexion and extension between T6 – L1.
(2) Ineffective in limiting lateral bending and rotation of the upper lumbar spine.
3. Indications
(1) Symptomatic relief of compression fractures not due to osteoporosis.
(2) Immobilization after surgical stabilization of thoracolumbar fracture.
(3) Thoracic kyphosis.
(4)用在脊椎椎體迫性骨折、雪曼氏症
4. Contraindications
(1) Compression fracture due to osteoporosis.
(2) Compression fracture above T6 since segmental motion increases above the sterna pad.
Taylor brace
1. Design
(1) TLS posterior uprights.
(2) Interscapular band to stabilize the uprights.
(3) Full front abdominal support.
2. Funtions:
(1) Restriction flexion and extension.
(2) Restricting rotation.
(3) Prevent kyphosis.
3. Indications:
(1) Conservative management of Kochs.
(2) Mild thoraco-lumbar injuries.
(3) Post-operative rehabilitation.
(4) 適用於 T10 以下的 compression fracture.
Knight-Taylor brace
1. Design
(1) Corset front made of canvas and provides intracavitary pressure.
(2) Lateral and posterior uprights.
(3) Shoulder straps to reduce lateral bending, flexion and extension.
(4) Pelvic band and cross supports below the inferior angle of the scapula.
2. Functions:
(1) Poor rotational control, limits flexion, extension and lateral bending.
(2) The ends of the pelvic and thoracic bands are anchored by the lateral uprights.
(3)適用於 T8 以下的問題
3. Contraindications:
(1) Unstable fractures that require maximum stabilization.
Osaka Medical College (OMC) type spinal brace
1. 是一種手臂以下式的脊柱側彎矯正裝具
2. 適用於脊柱側彎頂點在 T8 以下者
Cervical-thoracic-lumbar-sacral orthosis (CTLSO)
Milwaukee spinal brace
1. Design:
(1) Cervical region with a removable cervical rings.
(2) Also used is the thoracolumbar section of the orthosis in which the correction of the lower thoracic and
lumbar thoracic and lumbar spines is achieved.
2. Indications:
(1) Scoliotic management of the high thoracic curves along with thoracic and lumbar curves of the spine.
(2) Provides control of flexion, extension, and lateral bending of the cervical, thoracic, and lumbar spine.
(3)是一種手臂以上式的脊柱側彎矯正裝具
(4)適用於脊柱側彎頂點在 T8 以上者
Sacioiliac belt
1. Encircles the iliac crests and the trochanters.
2. Perineal straps prevent upward displacement
3. Functions: stabilize the SI joint.
4. Used in post-partum and post0traumatic SI seperations.

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