SPINAL ORTHOSIS

 

SPINAL ORTHOSIS

The common thoracic or lumbar orthosis consists of a plastic or aluminium

frame, anterior abdominal support, two posterior uprights, and pelvic and

thoracic bands, which are fitted to the spine.

 

Mechanism

The three point force control system of Jordan is used in these orthoses by

working on the principle of pelvic positioning, which acts as a base of support

for spinal column alignment. Relief of longitudinal forces is then provided

by anterior abdominal compression. Counter pressure is provided by a rigid

posterior positioning system. This arrangement provides increased comfort

as the forces are distributed over a wider area than with the three-point

pressure system.

In the three-point pressure system in the anterior spinal hyperextension

(ASH) brace, two anterior pressure points are balanced by a third opposing

posterior pressure point. This control system is effective in preventing flexion

deformities of the spine from becoming worse.

 

Principles

The client must be able to sit and stand comfortably while wearing the orthoses.

There should not be any problem with breathing, chewing or digestion.

 

Functions

The functions of spinal orthoses are manifold. They prevent and sometimes

even correct deformities like scoliosis and kyphosis. Where there is instability

or displacement they offer stability as in spondylolisthesis. Chronic back

sufferers get relief because these orthoses limit movement and weight bearing,

by limiting axial loading and relieving muscle spasm. After a spinal surgical

procedure or fracture vertebra, they protect against further injury.

 

TYPES OF SPINAL ORTHOSIS

Cervical Orthosis

Cervical orthosis surround and protect the cervical spine. They include the

collars which are the least restrictive and providing partial range of

motion. They are made up of foam plastic and surround the neck from the

lower jaw to the occiput and have rigid anterior and posterior struts. They

can be used in restriction of neck flexion and extension up to some extent.

Cervical collars are freely available in 3 readymade sizes—small, medium

and large and may be soft hard or medium depending on the restriction

needed.

Conditions Used

• Crush injuries of cervical spine

• In case of hyperextension injuries of cervical spine this type of collar is used

to hold the neck in a slightly flexed position.

• Whiplash injuries. These are caused by a sudden impact in which the head

and neck are thrown forward and backward abnormally. This sort of impact

is usually seen in car accidents, sports injury and child abuse.

• Sprains or strains of the neck.

• Degenerative diseases of the spine like cervical spondylosis.

 

Uses

• In the above-mentioned conditions the collar reminds the wearer not to move

abruptly, thus reducing stress on the damaged tissues.

• The collar retains body heat, which enhances circulation to the injured

structures.

• Immobilization of spine also helps in relieving pain.

• Prescription of the collar should only be done if the neck movement causes

severe pain, giddiness or is otherwise injurious to the anatomical structures.

Long term use is to be discouraged except when there is severe giddiness

or instability.

 

Head Cervical Orthosis (HCO)

The head cervical orthosis incorporates both head and the cervical spine into

the device, thus providing additional support and motion restriction.

 

Four Poster Cervical Orthosis

It has padded mandibular and occipital supports attached to anterior and

posterior plates by four rigid adjustable uprights. Laterally leather straps

connect the mandibular and occipital supports. This orthotic device provides

greater restriction of flexion, extension, lateral bending and rotation than the

ordinary collar.

 

Minerva Jacket

It is a suitable modified jacket, which is applied to the head and trunk.

Anteriorly, the orthosis has a forehead strap that secures the upper posterior

shell and a rigid mandibular plate. The axillae are also covered by a wool

roll.

 

Uses

• This provides excellent motion limitation in all directions.

• There is also the facility of selecting the optimal alignment of the head on

the neck.

 

Head Cervical-Thoracic Orthosis (HCTO)

Halo Orthosis: Better stabilization of the cervical spine is achieved through

external fixation of skull with reference to the chest. Three major components

include the rings and pins, plastic vest, and connecting adjustable uprights.

The pins penetrate the skin and outer table of the skull and are treated to fix

the halo ring assembly on the skull. Aluminium turnbuckles connecting the

jacket and ring are adjustable to provide variable traction, flexion or extension.

The orthosis is uncomfortable and cumbersome during exercises.

 

Conditions Used

• Paralysis with or without fracture of the cervical spine.

• Major cervical vertebral fracture with dislocation.

 

SOMI Brace

SOMI stands for Sterno Occipito Mandibular Immobilization, named for its

points of attachment, the sternum, occiput and mandible. The orthosis consists

of three parts; a chin cup with adjustable bar, an occipital support attached

to two bars for the anterior section and from which straps arise to attach to

the chin piece, and a sternal plate with straps for the shoulder pieces. SOMI

restricts flexion, extension, rotation and lateral bending.

Conditions Used

• Fracture of cervical vertebra (Lower level)

• In the case of non-operative or post-operative immobilization of spine.

 

Thoraco-Lumbar-Sacral Orthosis

These braces fix the pelvis and shoulder to prevent spinal movements in all

directions. They may be classified according to whether they control flexion,

flexion-extension, flexion-extension-lateral movement and all these including

rotary movements.

Hyperextension braces like the Jewett and ASH orthosis do not prevent

lateral or rotary movement. Flexion extension control orthosis like the Taylor

brace consist of two spinal uprights posteriorly. These are attached to a pelvic

band inferiorly and a band in the interscapular area above, providing

attachments to axillary straps which are held tight in order to effectively

control flexion extension. In addition an abdominal corset holds the abdominal

muscles bracing them against the spine. An optional plastic body jacket is

prescribed if maximum immobilization is needed as in Potts spine, or fractures

of the spine. The Knight-Taylor brace has additional lateral uprights to prevent

lateral motion of the spine. The Flexion-extension-lateral-rotary control orthosis

has an additional interscapular band extended anteriorly and superiorly to

control rotary movement.

 

Jewett Orthosis: This is an anterior hyperextension orthosis which has a

rectangular frame exerting pressure over the pubis and upper thorax. There

is a fulcrum maintained by a thoracic strap attached to the sides of the frame

offering counter support.

 

Conditions Used

• Compression fracture of the vertebra.

• Intervertebral disc desiccation and prolapse.

• Non-operative and postoperative immobilization of spine.

 

Uses: Restriction of flexion, extension and lateral flexion of the thoracolumbar

spine.

 

ASH Brace 

This spinal brace consists of a cross like frame anteriorly fixed with pads

on the sternum and the pubic symphysis with the pads at the extremes.

Posteriorly, in addition (in the Jewett orthosis) there is a padded support

in the thoraco lumbar region which maintains the spine extended by

the principle of Jordan. The ASH brace is more comfortable than the

Jewett brace.

Anterior spinal hyperextension brace (ASH)

which works on Jordans three point principle

Milwaukee Brace

The Milwaukee brace is a brace given for growing children with dynamic

scoliosis. It directs transverse and longitudinal forces actively

and passively.

The orthosis consists of a custom moulded or prefabricated plastic pelvic

girdle that serves as the foundation for pelvic positioning to control the lower

spine. This is accomplished by flattening of the abdomen to encourage pelvic

tilt and decrease lumbar lordosis. The anterior pelvic girdle is extended

superiorly to just below the xiphoid and the ribs, providing an anterior

compressive force. The remainder of the frame consists of anterior uprights

leading to a neck ring. The neck ring has an anterior throat pad and two

occipital pads that provide an additional longitudinal distraction force. The

lateral pads hold the lateral curves, but do not correct them. The pelvic band

fixes the pelvis and decreases lordosis. The collar head-band applies

distracting forces that elongate the spine.

Further modifications include pads attached at various levels of the

Milwaukee brace to correct other deformities of spine. There are buckles used

to distract the brace according to the height of the child. This is thus a dynamic

spinal brace that can ‘grow’ along with the children.

 

Conditions Used: Any lateral curvature of the spine - scoliosis and

kyphoscoliosis.

 

Lumbosacral Orthosis (LSO)

Knight Brace: It is a short spinal brace consisting of a pelvic band and a

thoracic band joined by two posterior and two lateral metal uprights which,

provide considerably more rigidity than a corset.

 

Boston Brace: The Boston brace is an example of modular orthosis that

provides varying control and is useful for the treatment of scoliosis. It is made

up of semi rigid plastic and supports the lower trunk by controlling all

lumbosacral motion.

 

Conditions Used

• Low back pain.

• Spondylolisthesis.

• Intervertebral disc diseases.

 

Uses

• The orthosis reminds the wearer to avoid abrupt motion.

• Motion control is achieved by means of various three-point force systems—

support for the spine is also by abdominal pressure.

 

Lumbosacral Corset

These are very common, and routinely used. Lumbosacral corsets may vary

in rigidity based on the amount and type of metal stays included. Longer length

corsets generally are used for more extensive spinal problems. A corset has

vertical reinforcements or a rigid posterior plate, but no rigid horizontal bands.

They are made of leather or canvas and contain elastic straps with Velcro

fastening for a close fit, and available off the shelf in various sizes.

 

Conditions Used: Many painful low back conditions associated with:

• Osteoporosis

• Lumbar spondylosis

• Malignancy

• Bad posture

• Spondylolisthesis

• Lumbosacral strain

• Sciatica.

 

Uses: Reduces pain by avoiding movement and in reducing contraction of the

erector spinae and consequently compression of intervertebral discs.

 

Sacral Orthosis

Sacral orthosis are the least restrictive spinal orthosis. They provide control

of the pelvis as a supportive base for the rest of the spinal column. They

are used in healing pelvic fractures, and relieving sacro-iliac pain

(sacroiliitis).

 

Sacro-Iliac Corset

It is a prefabricated device that can be adjusted anteriorly, posteriorly or

laterally with laces or hooks. Its superior borders lie at the level of the iliac

crest. Inferiorly its anterior border lies 0.5 to 1 inch above the pubic symphysis

and its posterior border extends to the gluteal fold.

This orthosis is thought to act by elevation of intra-abdominal pressure and

stabilization of the sacro-iliac joint and pubic symphysis.

THOSE ABOVE ARE COLLECTED FROM SOME BOOKS AND WEBSITES..

(TEXTBOOK OF REHABILITATION-SUNDER.S)

THANK YOU,

 SRIKUMARAN PHYSIOTHERAPY CLINIC & FITNESS CENTER