Spinal Orthotics Midterm: Practice Questions

What orthotic intervention can help manage pubic symphysis pain in pregnant women

sacroiliac orthosis

Spinal trauma can be associated with injury to which structures

vertebrae, spinal cord, ligaments, intervertebral discs

what ligament contributes to the stability of C2 in the presence of a Jefferson fracture

transverse ligament

which orthosis can be donned without moving the pt and is best at limiting cervical spine flexion

SOMI

which imaging technique should be utilized to identify potential damage to soft tissues in the spine

MRI

functional spinal unit consists of

2 vertebral bodies, facet joints, ligaments, intervertebral disc

which vertebral column is required for spinal stability

middle

severe flexion with rotation (bilateral facet dislocation)

what is the most likely mechanism of injury

which of the fractures are at the highest risk for neurologic injury

burst and chance

____ should be performed on all identified bony injuries of the spine as it provides significantly more detail on the fracture morphology compared to an x-ray

CT scan

which of the following is a true statement regarding custom fit orthosis and/or custom fab orthosis

a custom fab orthosis may be indicated instead of a custom fit orthosis in the presence of unusual bony habitus (or an unstable fracture)

which ligament is required to be intact to maximize spinal stability

posterior longitudinal ligament

what is included in the "on-site" evaluation of a spinal trauma

assessment of vehicular fatalities, assessment of mechanism of injury, extrication time and evaluation of exposure to the environment

the vast majority of spinal injuries occur in what region of the spine

thoracolumbar

spinal radiographs of a ____ fracture show a wedge shaped vertebrae with or without loss of height of the vertebrae

compression fracture

what can be used to improve stability for injuries below L4

hip spica

the spinous process of the thoracic spine are approximately level with what

the vertebral body below

if a pt presents with an injury at the T9 vertebral body, the orthosis must cover which range of spinal levels

T6-T12

the structure of the Dens allow for what natural spinal movement

rotation

what type of orthosis would you most likely use for a pt with a pathology to the anterior column at T10

hyperextension orthosis (CASH or Jewett)

which of the following is NOT a goal of surgical treatment for neuromuscular scoliosis

-increase repositioning (you want to dec.)

**IS a goal: prevent curve progression, improve sitting balance and skin tolerance in sitting, improve cardiopulmonary function

spondylolisthesis is typically associated with unilateral fracture of the pars interarticularis and anterior slippage of one vertebra on another

False (bilateral fracture)

Complications related to the HALO

nerve damage, infection, pin loosening, pin discomfort, scarring, dysphagia and pin site bleeding

possible clinical presentations of spondylolisthesis

-tingling, numbness or weakness in one or both legs

-tight hamstrings

-difficulty walking

_________ is a condition that involves only a defect or stress fracture in the pars interarticularis of the vertebral arch

spondylolysis

a pt presents with fractures at T3, T9 and L3. What is the most appropriate orthotic recommendation

CTLSO

the best orthotic recommendation for hypotonic pts with neuromuscular scoliosis is

soft TLSO

neuromuscular scoliosis may be divided into 2 major subtypes

myopathic and neuropathic

the posterior trimline of a custom TLSO extends superiorly to what anatomical landmark

spine of the scapula

______ is one example of an upper motor neuron lesion that could result in neuromuscular scoliosis

Parkinsons

__________ is one example of a lower motor neuron lesion that could result in neuromuscular scoliosis

Guillan Barre

the spine of the scapula is an anatomical landmark for which vertebral level

T3

what spinal orthosis restricts flexion at the atlantoaxial and C2-C3 segments better than any other CTO

SOMI

what are the goals of treatment for adult/geriatric pts with neuromuscular scoliosis

-improve sitting comfort and sitting tolerance

-provide mild realignment of the trunk and pelvis

-facilitate care

complete slippage of one vertebra on another is known as:

spondyloptosis

the HALO is indicated for complete immobilization of _____ and/or ________

C1 and C2

_______________ is the anatomical landmark for the T2 vertebra

sternal notch

Spondylolisthesis is most common at what spinal level

L4-L5 and L5-S1

What are some of the most common goals for utilizing the LSO anterior overlap orthosis for treatment of spondylolisthesis/spondylosis

dec. lordosis, dec. pain and inc. intra-abdominal pressure

in the non-operative management of neuromuscular scoliosis, goals for the pt include:

improve upper extremity function, slow curve progression and maintain or improve cardiopulmonary function

the goal of orthotic intervention in treating neuromuscular scoliosis is to prevent curve progression

false (just slow progression)

where would you provide compression during a bivalve casting to prevent rotation of the TLSO and help hold it in place

the waist

which of the following diagnoses is not considered to be caused by an upper motor neuron lesion

Guillan Barre Syndrome

Multiple Sclerosis

Parkinson's

Spinal Cord Tumor

Guillan Barre

curve progression can continue beyond skeletal maturity in a pt with neuromuscular scoliosis

true

Which is NOT a reason to use an orthosis in the treatment of neuromuscular scoliosis

Correct curve progression

Delay surgical intervention

Improve function by freeing hands

Improve sitting balance

correct curve progression

the orientation of the facet joints determine what motion is available between vertebra. The orientation of the facets on the thoracic vertebra allow thoracic ________ and limit _______

lateral flexion

flexion and extension

where are lower motor neuron lesions located

peripheral nervous system

a unilateral pars defect without forward slippage

spondylolysis

this is the primary motion achieved from the atlanto-axial joint

rotation

facet joints are in the closed position during

extension

Scheurmanns kyphosis is classified by

-thoracic kyphosis >45 degrees

-wedging of at least 3 vertebra

-narrowing of the disc space

what percentage of slippage is a grade 3 spondy

75%

what test provides the most detail on fracture morphology for bony injuries of the spine

CT scan

how many spinal levels above and below should a stable injury be included in an orthosis

3 above and 3 below

what ligament must be intact for maximal spinal stability

posterior longitudinal ligament

what spinal level is most commonly affected by spondylolisthesis

L5-S1 and L4-L5

what pathology/pathologies are best treated by a hyperextension orthosis

anterior compression fracture

when should orthotic treatment begin for a pt with neuromuscular scoliosis

> 20-25 degrees

scoliosis is a two dimensional abnormality of the spine

false (3D)

what symptoms are included in the clinical presentation of spondylolisthesis

back pain, inc. pain with standing but dec. pain with sitting, pain radiating in buttocks

Which of the following is NOT a complicating factor of Neuromuscular Scoliosis?

Seizures

Incontinence

Increased sensation

Dislocating hips

Increased sensation (a complicating factor is dec. sensation)

what is the mechanism of injury for bilateral facet joint dislocations

flexion and rotation

what are the indications of minerva orthosis

C3-T4 fractures

what is the forehead strap in the SOMI used for

to allow the pt to eat

who is most likely to need an SI belt

a young gymnast

a pregnant woman

an elderly man

a toddler

a pregnant woman

burst fractures are often unstable

true

the anterior trimline of a custom TLSO extends superiorly to what anatomical landmark

sternal notch

You obtain a prescription from the doctor that states the patient is in need of an orthosis to help with healing an anterior compression fracture at T12. The patient is 65 y/o and 130bs.

What are the considerations?

-What spinal levels need to be included in the trimlines: T9-L3

-Is this fracture stable or unstable?: Stable

-What do you need to consider when deciding the device you want to fit on this pt: Age, weight, abnormal anatomy, activity level, donning/doffing, pain, hyperextension moment

You obtain a prescription from the doctor that states the patient is in need of an orthosis to help with healing an anterior compression fracture at T12. The patient is 65 y/o and 130bs.

What is your orthotic recommendation?

CASH hyperextension orthosis; Sternal pad sits ½" below sternal notch, pubic pad sits ½" above pubic symphysis, posterior pad should avoid putting pressure on injured vertebre

Your patient has been in a car accident and has a hangman's fracture at C2. The patient is 25 y/o and 200 lbs

What are your considerations?

-What is the mechanism of injury of the hangman fracture: Hyperextension followed by distraction

-What are some considerations for this pt: Level/ type of fracture, fractures to other anatomy, abnormalities

-What is your orthotic recommendation if the fracture is stable: Minvera, CTO

Your patient has been in a car accident and has a hangman's fracture at C2. The patient is 25 y/o and 200 lbs

What is your orthotic recommendation?

the HALO

A 6 year old female patient presents with a diagnosis of Cerebral Palsy and a scoliosis curve of 24.° She is 38 inches tall and weighs 32 pounds. The patient has limited ambulation and most often uses a wheelchair to get around.

What type of neruomuscular scoliosis is this?

Neuropathic (upper motor neuron)

A 6 year old female patient presents with a diagnosis of Cerebral Palsy and a scoliosis curve of 24.° She is 38 inches tall and weighs 32 pounds. The patient has limited ambulation and most often uses a wheelchair to get around.

What potential non-anatomical landmarks would you mark during castin?

baclofen pump/G-tube

A 6 year old female patient presents with a diagnosis of Cerebral Palsy and a scoliosis curve of 24.° She is 38 inches tall and weighs 32 pounds. The patient has limited ambulation and most often uses a wheelchair to get around.

Discuss the 4 main goals of non-operative management of neuromuscular scoliosis

-maintain balance of spine over level pelvis

-improve upper extremity function

-reduce risk of skin breakdown (pressure, friction, temperature, moisture)

A 6 year old female patient presents with a diagnosis of Cerebral Palsy and a scoliosis curve of 24.° She is 38 inches tall and weighs 32 pounds. The patient has limited ambulation and most often uses a wheelchair to get around.

Orthotic recommendation

Thermoplastic TLSO with liner

-CP usually present with spasticity

-max control of pelvis

-excellent costal margin purchase

-3 opening designs: anterior, posterior and bivalve