SCOM - Principles and Components of Spinal Orthoses - Lumbar and Thoracic

What are the three main principles of biomechanical control for spinal orthoses?

1. 3 point pressure system

2. hydrostatic compression

3. kinesthetic reminder

Abdominal compression may lead to decreased loading on the spinal column.

vertical

Hydrostatic compression is not applicable for the cervical spine. True or false?

true

What are the two main principles of spinal surgery?

skeletal fixation

distraction

True distraction of vertebrae is achieved only through surgical intervention or the HALO. True or false?

false - only surgical intervention (HALO is the closest we come, but still not true distraction)

What are possible drawbacks to spinal orthoses?

skin breakdown

localized pressure/pain

psychological dependence

physical dependence (muscular weakening?)

What is the main drawback to any spinal stabilization?

increased motion at immobilization ends

vertebral joints superior and inferior to immobilization have greater demands for motion

How is abdominal compression achieved?

circumferential compression over the waist

What does abdominal compression achieve?

unloading/distraction of the spine (offloading of internal structures)

Spinal traction is a form of therapy that relieves pressure on the spine.

decompression therapy

Spinal traction is often used for the thoracic spine. True or false?

false - cervical

What is the primary motion in the lumbar spine?

FL/EXT

The greatest FL/EXT and least bending/rotation occurs at what joint?

L5/S1

What characterizes the sacroiliac joint?

weight bearing

interlocking

synovial joint

articulation between sacrum and pelvis

What characterizes an elastic abdominal binder?

elastic circumferential wrap

canvas or fabric based

apply by fastening velcro straps anteriorly

intended for lumbar use only

There is a viable CMS code for elastic abdominal binders. True or false?

false - just tell them to get it at CVS

What characterizes a lumbosacral corset?

flexible

removable stays for EXT stop

provides compression

biomechanical capacity

increase hydrostatic compression

support spine and reduce pain

decrease lumbar lordosis/EXT

What characterizes an LSO corset with a rigid panel?

corset with rigid posterior panel (L1-L5)

compression

removable stays

biomechanical capacity

limits lumbar EXT/lordosis

increases intercavitary pressures

cannot immobilize spine

What is the difference between the Chairback vs Knight LSOs?

all are conventional rigid LSOs with corset front

Chairback

horizontal lateral supports

more contoured

rigid lateral and posterior frame

limit EXT and lateral bending

hydrostatic compression

Knight

vertical lateral supports

less contoured

rigid lateral and posterior frame

limit EXT and lateral bending

What characterizes a Williams Flexion LSO?

promotes FL

limits EXT and lateral bending

hydrostatic compression

end point control (good control of lumbar spine)

Which brace provides end point control?

Williams Flexion LSO

What characterizes a semi-rigid LSO?

circumferential spinal orthosis

T9-sacrococcygeal junction

semi-rigid panels for support

biomechanical capacity

reduces vertical load (hydrostatic compression)

reduces motion in lumbar spine (panels)

What characterizes a thermoplastic LSO?

prefabricated or custom fabricated

rigid anterior and posterior frames

from T9-sacrococcygeal junction

What are the trimlines for a custom thermoplastic LSO?

anterior/superior: 12mm inferior to xiphoid process, incorporating inferior costal margin

anterior/inferior: 12mm superior to pubic symphysis, inferior to the ASIS with adequate clearance for rectus femoris

posterior/superior: 12mm inferior to inferior angle of scapula (clear scapular wing)

posterior/inferior: sacrococcygeal junction

The custom LSO trimline are based upon the principles of .

endpoint control

What are the biomechanical capacities of a custom molded LSO?

intimate fit

rigid, semi-rigid, or flexible

increase hydrostatic compression

limit FL/EXT/LAT/ROT

does not provide adequate thoracic motion control

trimlines custom for user

Does a custom fabricated LSO provide adequate thoracic motion control?

no

What are two types of hyperextension TLSOs?

1. CASH TLSO

2. Jewett TLSO

What characterizes a thoracolumbar corset?

inelastic

canvas/fabric

circumferential wrap with thoracic extension

rigid stays

shoulder straps

velcro straps/anterior snaps

increases hydrostatic compression

What characterizes the Taylor TLSO?

conventional or thermoplastic TLSO

components: pelvic band, paraspinal bars, interscapular band, axillary straps, corset abdominal support

biomechanical capacity

limit FL/EXT (primarily limit thoracic FL)

The interscapular band is the primary directed force to limit flexion in the Taylor TLSO.

anteriorly-directed

The axillary straps are the primary directed force to limit flexion in the Taylor TLSO.

posteriorly-directed

What characterizes the Knight-Taylor TLSO?

conventional TLSO

components: thoracic band, pelvic band, paraspinal bars, lateral bars, interscapular band, axilla straps, corset abdominal support

biomechanical capacity

limit spinal FL/EXT/LAT bending

The Taylor TLSO has lateral bars and the Knight-Taylor TLSO does not. True or false?

false - opposite

What is a hyperextension TLSO?

TLSO that promotes upright position while preventing flexion

often used for anterior compression fracture, Scheuermann's kyphosis, etc.

What does CASH stand for?

cruciform anterior spinal hyperextension orthosis

What is a CASH orthosis?

hyperextension orthosis

anterior super-structure

posterior straps for central support point

What is a Jewett orthosis?

hyperextension orthosis

lateral supra-structure

rigid tab for central support point

What characterizes a semi-rigid TLSO?

circumferential spinal orthosis from SC junction to above T9

incorporates semi-rigid panels for support

biomechanical capacity

reduces vertical load (hydrostatic compression)

reduces motion in thoracic/lumbar spine with panels

cannot immobilize spine

What characterizes a custom molded TLSO?

thermoplastic

from SC junction to above inferior angle of scapulae (above T9)

biomechanical capacity

hydrostatic compression

limits FL/EXT/LAT/ROT

customize to patient's needs

TLSOs typically extend above T9 to approximately .

T7

What are the trimlines for a custom thermoplastic TLSO?

anterior/superior: 12mm inferior to sternal notch

anterior/inferior: 12mm superior to pubic symphysis, inferior to ASIS with adequate clearance for rectus femoris

lateral/superior: 37mm inferior to pectoralis tendon for adequate clearance

lateral/inferior: 12mm proximal to greater trochanter

posterior/superior: 12mm inferior to lowest point of scapular spine

posterior/inferior: sacrococcygeal junction

What characterizes a rib belt?

elastic strap around rib cage

may be used for chest muscle strain or rib fracture

may restrict breathing (pneumonia)

remove 4x/day

What characterizes a pectus orthosis?

used for pectus carinatum

pectus orthosis or "TO"

custom fit or custom fabricated

adjustable (accommodate deformity reduction)

goal: apply tolerable posteriorly-directed pressure to sternal protrusion

What characterizes a hip spica?

thigh cuff connected to spinal orthosis (rigid or with joint)

custom of prefabricated

hip joint ROM set by MD (typically limited to 30-60 degrees of locked at 45 degrees)

When do you choose to use a hip spica?

impairment of L4, L5, and/or S1 (unrestricted hip FL translates to motion at L5/S1 and possible higher)

What is the goal of a sacroiliac orthosis?

treat sacroiliac joint dysfunction

What is one sacroiliac orthosis and what does it do?

sacroiliac belt (SI belt)

applies medially directed forces bilaterally on iliac crests (reduces motion at SI joint)

What is the 3PPS for controlling extension/aiding flexion?

1 posteriorly-directed corrective force

2 anteriorly-directed stabilizing forces (inferior and superior)

What components of conventional orthoses accomplish anterior control when controlling extension/aiding flexion?

corset/apron front (LSO/TLSO)

What components of conventional orthoses accomplish posterior control when controlling extension/aiding flexion?

thoracic band (LSO)

interscapular band (TLSO)

pelvic band (LSO/TLSO)

What is the 3PPS for controlling flexion/aiding extension?

1 anteriorly-directed corrective force

2 posteriorly-directed stabilizing forces (inferior and superior)

What components of conventional orthoses accomplish anterior control when controlling flexion/aiding extension?

proximal/distal corset/apron front (LSO/TLSO)

sternal pad (TLSO)

axilla straps (TLSO)

Sternal pads should be distal to the sternal notch.

1/2" distal

What components of conventional orthoses accomplish posterior control when controlling flexion/aiding extension?

paraspinal bars (LSO/TLSO)

What is the 3PPS for controlling lateral bending/aiding contralateral bending?

1 medially-directed corrective force

2 laterally-directed stabilizing forces (inferior and superior)

(or vice versa)

What components of conventional orthoses accomplish ipsilateral control when controlling lateral flexion/aiding contralateral flexion?

lateral thoracic band (LSO/TLSO)

lateral pelvic band (LSO/TLSO)

What components of conventional orthoses accomplish contralateral control when controlling lateral flexion/aiding contralateral flexion?

lateral upright (LSO/TLSO)

To control rotation, a thermoplastic orthosis acts proximally at the and distally at the .

ribs/scapulae

iliac crests/trochanter

What components of conventional orthoses accomplish rotational control?

thoracic bands (LSO/TLSO)

pelvic band (LSO/TLSO)

interscapular band (TLSO)

paraspinal bars (LSO/TLSO)

lateral uprights (LSO/TLSO)