1. Spinal orthosis

2. Outlines Spinal orthosis Nomenclature for spinal orthosis
Orthotics in the treatment of low back pain
Traditional spinal orthosis
Thermoplastic spinal orthosis
Orthotics in spinal deformity: Scoliosis

3. Spinal orthoses
Spinal orthoses are designed to do one or more of the following:
Immobilize gross spinal motions.
Immobilize individual motion segments.
Apply external forces to correct deformity or to prevent progression of deformity.

4. Nomenclature for spinal orthoses
SIO: Sacroiliac orthoses encompass the sacral and iliac regions of the lower spine and pelvis.
LSO: Lumbosacral orthosis encompass the lumbar and sacral regions of the lower spine.
TLSO: Thoracolumbosacral orthoses encompass the thoracic (ribs), lumbar , and sacral regions of the spine.
CTLSO: cervicothoracolumbosacral orthoses encompass the cervical (neck), thoracic, lumbar, and sacral region.
CO: Cervical Orthoses encompass the cervical spine region.
CTO: cervicothoracic orthoses encompass the cervical and thoracic regions of the spine.

5. 1) Orthotics in the treatment of low back pain
The primary goal of an orthosis in the management of low back pain is to decrease pain most designs accomplish this by
Limiting motion in the lumbar spine.
Provide greater abdominal support

6. An orthosis that supports the lumbar spine in optimal posture may be an effective conservative treatment modality for low back pain.
A wide variety of orthotic designs are used to meet this goal, ranging from lubosacral (LS) corsets to rigid thermoplastic thoracolumbosacral orthoses (TLSOs)

7. Lumbosacral corsets
LS corsets encompass the abdomen and the pelvis. In exerting circumferential pressure,
The anterior borders of LS corset are superior to the symphysis pubis and inferior to the xiphoid process.

8. Lumbarsacral Corsets are custom fitted to each client and offer interabdominal support which helps to relieve
lumbar sacral back pain,
lower back pain
and other general lower back ailments.

9. 2) Traditional spinal orthoses
Traditional metal and leather spinal orthoses provide
motion control and
trunk support

10. Traditional spinal orthoses
Sagittal control lumbosacral orthoses: the chairback orthosis
Sagital-coronal control lumbosacral orthoses: The knight Orthosis
Extension-coronal control lumbosacral orthosies : The Williams Orthosis
Flexion control thoracolumbosacral othoses: The Jewitt and Cash Orthosis

11. Sagittal control lumbosacral orthoses: the chairback orthosis
A spinal orthosis that is designed to control motion in sagital plane is the chairback LSO,
which has a thoracic and pelvic band connected by two paraspinal bars.
This orthosis is prescribed when patient΄s condition requires reduction of gross and intersegmental flexion and extension motion of the trunk.

12. Sagital-coronal control lumbosacral orthoses: The knight Orthosis
When a pair of lateral bars is added to the orthosis, control of spinal motion is possible in the coronal (frontal) as well as sagittal plane.
This orthosis, also known as knight spinal orthosis, has thoracic and pelvic bands connected by a set of paraspinal bars and set of lateral bars, with an anterior half –corset closure

13. Sagital-coronal control lumbosacral orthoses: The knight Orthosis
This orthosis was originally designed for patients with tuberculosis of the spine but is now used primarily in the management of low back pain.

14. Extension-coronal control lumbosacral orthosies : The Williams Orthosis
The Williams LSO is a dynamic orthosis
that has a thoracic and pelvic band, a pair lateral bars, and a set of oblique bars positioned between the thoracic band and lateral bars are mobile.
The articulation between the thoracic band and lateral bars allows the patient to move into some trunk flexion in the sagittal plane.
Back View

15. Extension-coronal control lumbosacral orthosies : The Williams Orthosis
Williams LSO was originally designed as a treatment for spondylolisthesis.

16. Flexion control thoracolumbosacral othoses: The Jewitt and Cash Orthosis
When compression fracture of the lumbar or low thoracic spine has occurred, it is very important to limit trunk flexion during healing process.

17. Flexion control thoracolumbosacral othoses: The Jewitt and Cash Orthosis
Two orthoses are designed to limit flexion while encouraging trunk hyperextension are
Jewitt TLSO flexion control orthosis and
Cash hyperextension orthosis

18. JEWITT ORTHOSIS
CASH ORTHOSIS

19. Orthotics in spinal deformity: Scoliosis
Scoliosis, also known as curvature of the spine, is a three- dimensional, progressive deformity of the spine.
The Milwaukee brace, a cervicothoracolumbosacral orthosis (CTLSO) with a fit pelvic component, anterior and paraspinal bars, corrective pads and neck ring, was developed 1950s as a nonoperative treatment.

20. Comparison of spinal alignment between unaffected person and a person with right idopathic scoliosis

21. Orthotic options for patients with scoliosis
The effectiveness of the Milwaukee brace as an orthotic intervention for spinal deformities in children is well documented.
In a primary thoracic curve with an upper end point at T5, for example, maximum spinal stability and curve correction are achieved with the trim line/counterforce at T5-6 and a pad at the apex.

22. Milwaukee brace

23. Orthotic intervention for spinal deformity: Kyphosis
Kyphosis, a hyperflexion of the spine (round back), can be the result of neuromuscular impairment, congenital anomalies, or degenerative changes in the spine e.g Scheuermann΄s disease
Othotic intervention is more successful in managing kyphosis that results from Scheuermann΄s disease than that caused by other etiologies.

25. Orthotics for treatment of spinal fractures
The primary function of orthoses in the management of patients with spinal fracture is to provide biomechanical stability.
An orthosis can stabilize the spine in one or more of the following ways:

26. 1)Limitation of gross motion of the trunk to reduce movement and sway of the vertebral column during activities of daily living. 2)Reduction of segmental motion of the spine. 3)Positioning of the spine in hyperextension using a three-point force system to permit optimal bony healing.