1. Department of Rehabilitation Nakornping hospital
Spinal orthosis
Department of Rehabilitation
Nakornping hospital

2. References
Delisa JA : Physical medicine and rehabilitation, 4th ed. Williams and Wilkins
• Braddom RL : Physical medicines and rehabilitation, 4th ed. Saunder Elsevier
• 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

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

7. Cervical orthosis CO CTO Flexible Soft collar Hard collar Rigid
Philadephia
Miami J
Malibu
Aspen
Newport
Halo
SOMI
TMBJ
Yale
Four-poster

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

9. SOMI ( Sterno-Occipital-Mandibular Immobilizer)
@ 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.
Flexion control
C1-4
Function
Indication
F-E-R control
Pressure system : control motion and distraction
Provide supine position
Good for bed restricted pt.
Stable spinal injury above C5
Post op. management

10. Cervical control Flexion Extension Lateral flexion Rotation Axial load
Flexion control
C1-4
Only !!!
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

11. Checkout

12. Don - Doff

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

14. Cervical control Flexion Extension Lateral flexion Rotation Axial load
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. Thoracolumbar orthosis
TLSO
LSO
Flexible
Thoraco-lumbosacral
corset
Lumbosacral corset
Lumbar binder
Rigid
Taylor
Knight- Taylor
Cowhorn
Jewett, CASH
Chairback
Knight
Williams

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

18. Jewett control Flexion control only!!! of T-L spine Flexion Extension
Lateral
flexion
Rotation
Axial load
Thoracic S F
F or S-
Lumbar
Lumbosacral S-
Flexion
control only!!!
of T-L spine

19. Checkout

20. Don - Doff

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

23. Taylor control F-E control of T-L spine Flexion Extension Lateral
Rotation
Thoracic S F S-
Lumbar
Lumbosacral CI
F-E control
of T-L spine
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

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

26. Knight-Taylor control
Flexion
Extension
Lateral
flexion
Rotation
Thoracic S S- F
Lumbar
Lumbosacral CI

27. Checkout

28. Don - Doff

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

30. Chairback control F-E only!!! Flexion Extension Lateral flexion
Rotation
Lumbar S S-
Lumbosacral
F-E only!!!
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

31. Checkout

32. Don - Doff

33. Willium control Flexion Extension Lateral flexion Rotation Lumbar F S
Lumbosacral