1. Spinal orthosis Department of Rehabilitation Nakornping hospital

2. References  Delisa JA : Physical medicine and rehabilitation, 4th ed. Williams and Wilkins. 2005.  Braddom RL : Physical medicines and rehabilitation, 4th ed. Saunder Elsevier. 2011.  Spinal Orthosis. NYU 1983.  Hoppenfeld S : Orthopaedic neurology: a diagnosis guide to neurologic levels,  Philadelphia, Lippincott Williams & Wilkins, 1977.  Hsu JD, Michael JW, Fisk JR : AAOS Atlas of orthoses and assistive devices, 4th ed.  Philadelphia. 2008.

3. Outline  General basis of spinal orthosis  Classification  CO, CTO, CTLO,TLSO, LSO, SO,CTLSO  Prescription and things to consider

4. General basis of spinal orthosis  Mechanism of action  Indications  Negative effects

5. Mechanism of action Increase in intraabdominal pressure Trunk support Reminder >> Limit spinal motion Control of motion Three-point force system Spinal alignment

6. Trunk support  Reduce vertical loading on T-L spine  Reduce demand of spinal extensor musculature  Increase spine stability

7. Control of motion  Kinesthetic reminder  Limit intersegmental spinal motion

8. Spinal alignment  Sagittal control (flexion/extension)  Coronal control (Lt. tilt control)  Transverse control

9. Indications  Soft tissue injury  Spinal instability  Fracture  Dislocation  Post-op  Spinal deformity

10. Classification  CO  CTO,CTLO  TLSO  LSO  SO  CTLSO

11. Cervical orthosis COCTO FlexibleSoft collar Hard collar RigidPhiladephia Miami J Malibu Aspen Newport Halo SOMI TMBJ Yale Four-poster

12. Philadelphia collar Indication Prehospital trauma immobilization Soft tissue injury Post-op stabilization Post Halo removal Unstable Fx > Surgery > Rigid CTO > Philadelphia

13. Miami JAspenMalibu

14. Cervical control FlexionExtensionLateral flexion RotationAxial load S- or SS- F F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

15. SOMI ( Sterno-Occipital-Mandibular Immobilizer) Function  F-E-R control  Pressure system : control motion and distraction  Provide supine position Indication  Good for bed restricted pt.  Stable spinal injury above C5  Post op. management Flexion control C1-4 @ Chest piece connected by uprights (going from ant. to post.) to occipital plate. So, easily applied to supine pt. @ Removable chin piece so pt. can eat, wash, or shave while lying supine.

16. Cervical control FlexionExtensionLateral flexion RotationAxial load SS- S F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion Flexion control C1-4 Only !!!

17. Checkout

18. Don - Doff

19. Halo Function  F-E-L-R control  Greatest restrict motion (all planes) Indication  Post-op. unstable cervical fracture (esp. occiput-C1)  Post op. management - Rigid metal or graphite ring attached to skull with 4 pins, 4 posters, plastic body vest

20. Cervical control FlexionExtensionLateral flexion RotationAxial load SSSSS F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

21. TMBJ (Thermoplastic Minerva Body Jacket) Function  F-E-L-R control, but less restriction of motion compared to Halo vest  Comfort, lighter  Not invasive Indication  Effective in lesion below C2 (occiput-C1 : Halo)  May be preferred orthosis for preschool age children Total contact orthosis with fixation points at chin, Circumferential forehead piece

22. Cervical control FlexionExtensionLateral flexion RotationAxial load SSSSS F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion ไม่มีในโรงพยาบาลนคร พิงค์

23. Thoracolumbar orthosis TLSOLSO FlexibleThoraco-lumbosacral corset Lumbosacral corset Lumbar binder RigidTaylor Knight- Taylor Cowhorn Jewett, CASH Chairback Knight Williams

24. Rigid TLSO : Jewett Brace Function  TLS flexion control  Immobilize lower T & upper L  Single three-point force system Indication  Stable compression fracture of T12-L1  Obesity Ant. hyperextension brace

26. Jewett control FlexionExtensionLateral flexion RotationAxial load ThoracicSFF or S- LumbarSFF or S- LumbosacralS-FF or S- Flexion control only!!! of T-L spine

27. Checkout

28. Don - Doff

29. Rigid TLSO : Taylor brace Function  TLS flexion control  Immobilize lower T & upper L  Elevate intraabdominal pressure Indication  Post-op of traumatic fractures,spondylolisthesis. scoliosis, spinal stenosis, HNP, and disk infection  Stable multiple compression fracture of T spine (osteoporosis)

31. Taylor control FlexionExtensionLateral flexion Rotation ThoracicSSFS- LumbarSSFS- LumbosacralCI FF F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion F-E control of T-L spine

32. Rigid TLSO : Knight-Taylor brace Function  TLS F-E-L control  Immobilize lower T & upper L Indication  Post-op of traumatic fractures,spondylolisthesis. scoliosis, spinal stenosis, HNP, and disk infection  Stable multiple compression fracture of TL spine

34. Knight-Taylor control FlexionExtensionLateral flexion Rotation ThoracicSSS-F LumbarSSSS- LumbosacralCI S-

35. Checkout

36. Don - Doff

37. Rigid LSO : Chairback brace Function  Increase intraabdominal pressure  F-E control Indication  Lower lumbar pathology  Post surgical support

38. Chairback control FlexionExtensionLateral flexion Rotation LumbarSSS- LumbosacralSSS- F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion F-E only!!!

39. Checkout

40. Don - Doff

41. Rigid LSO : Knight brace Function  Increase intraabdominal pressure  F-E-L control Indication  Lower lumbar pathology  Post surgical support Knight brace = chairback brace + Lateral bar

42. Knight control FlexionExtensionLateral flexion Rotation LumbarSSSS- LumbosacralSSSS- F = No restriction of motion as a function of the orthosis, or minor enough to be ignored S = Restricted motion to a clinically significant extent S- = Intermediate degree of motion restriction CI = Compensatory increase in motion

43. Rigid LSO : William brace Function  Dynamic spinal orthosis  E-L control Indication  Spondylosis  Spondylolisthesis  Not for compression fracture Oblique lateral bar

44. Willium control FlexionExtensionLateral flexion Rotation LumbarFSSS- LumbosacralFSSS-