1. Uses of spinal orthotics: 1)Pain (back pain) 2)Restriction of spinal motion. 3)Postural care and postural correction. 4)Augment other therapies

2. General classifications of spinal orthosis Flexible orthotics: Or corsets They are constructed out of strong fabrics or elastic materials with a variety of stiffer supports Rigid spinal orthotics They are used when greater control of motion or posture is required. They are fabricated from high temperature thermoplastics or light weight metals. There are wide varieties with a broad selection of pads and coverings.

3. Therapeutic benefits of spinal orthosis Intra abdominal pressure: They create cylinder effect, exert pressure on the abdomen, and raise intra-cavitary pressure and reduce the intra-discal pressure especially during forward bending. Muscle relaxation: Support the vertebral column and relaxing the abdominal and erector spinae muscles Decreasing the need for contractile support of the vertebral column may relax the muscles and reduce existing pain.

4. Restriction of motion: The primary method employed for motion control is the three point pressure system. A rigid system is used when cervical, thoracic and lumbosacral motions are sought to be limited to the greatest possible degree. The amount of limitation varies between the various segments. Reduction of motion will reduce pain and spinal instability and offer constant proprioceptive feedback, reinforcing positive behaviors. Postural realignment: ↑intra abdominal pressure, relaxation in muscle spasm, and restriction of movement can assist in facilitation of improved posture and reduce compensatory posture related pain. E.g. In case of scoliosis, the use of orthosis may prevent a spinal progression, stabilize the curvature and may offer some degree of posture correction

5. Flexible Orthoses Or Corsets Sacroiliac corset (binder) Lumbsacral corset Thoracolumbosacral corst

6. Flexible Orthoses Or Corsets 1)Sacroiliac corset (binder):  Made from a combination of fabrics, elastic, laces and velcro offering multiple adjustments  Encircle the waist from the iliac crest to the greater trochanter and extending anteriory to the symphysis pubic.  Provide postural stability and reinforcement. 2)Lumbsacral corset:  Made from heavy fabrics with laces and hooks.  It is designed to limit motion, maintain three point pressure system and to reduce pain

7. 1)Thoracolumbosacral corset: (TLSO)  The same construction and function of lumbo-sacral corset (LSO) except it includes a shoulder strap to restrict spinal motion to the thoracic region as well as to the lumber spine

8. Rigid Orthoses Lumbsacral orthosis (Williams Extension Lateral control): Fabricated from light weight materials such as leather and vinyl. Asingle three point pressure system limits trunk extension in lumber spine and increase interabdominal pressure. Lordosis is decreased, pelvic and thoracic bands exert a medial force that tend to limit lateral trunk motions, no limitation of trunk flexion

9. Thoracic lumbo-sacral orthoses Taylor (Flexion/extension control): A pelvic band connects with two posterior uprights terminating at the mid-scapular level of the thoracic region. The three point pressure systems are coupled together to limit both flexion and extension of the lumber and thoracic spine. Jewett (flexion control):--------------→ A three point pressure system is created with two pads, one across the sternum and one at the symphysis pubis, providing the counterforce with a single pad posteriorly to promote hyperextension and restricting forward flexion.

10. Plastic body jacket (flexion-extension-lateral rotary control) It is fabricated with high temperature copolymer plastics It will restrict motion in all planes. Anterior and lateral trunk support will elevate intracavitary pressure, and decrease demands on the vertebral disks It is used post-surgically or during acute trauma.

11. Cervical Orthoses Soft collar:  made from soft foam, provides mechanical restraint for cervical flexion and extension, and to a lesser degree lateral flexion and rotation  It is a transitional device from more rigid orthoses  It acts as a proprioceptive reminder and to limit head and neck motions

12. Hard collars (Philadelphia collar):  Made from semirigid and rigid plastics  Provide more stabilization of cervical spine andchin and occipital support  With the inferior collar extending to the sternal notch and to the T3 spinous process posteriorly.  It permit 40 to 50 percent of normal cervical ROM

13. Cervicothoracic orthoses: (Sterno-occipital mandibullar immobilizer (SOMI): It is one of the most common post surgical device It consists of a rigid metal frame with a chin and occipital rest connected to a chest and back plate,with padded shoulder and trunk straps It reduces cervical motion to about 55 to75 percent.

14. Halo cervical orthosis: It has a greatest reduction in cervical mobilization. It consists of a cranial ring secured to the skull using four metal pins. The ring is attached by four metal bars to a plastic vest and is worn continuously The estimated reduction in all cervical motions is 90 to 95 percent. It provids spinal stabilization and reduces the load of the head on the cervical spine.

15. Cervicothoracolumbosacral Orthosis The CTLSO is the most commonly used for the treatment of scoliosis and Kyphosis. Milwaukee brace is designed with a neck ring and occipital pad, connected to four metal upright bars secured to plastic TLSO extends distally, forming a molded pelvic section.  The advantage of Milwaukee brace is that each component pelvic, thoracic, and cervical can be molded.  The disadvantage of this orthosis is that brace must be worn for 12 to 18 months, 23 hours a day and taken out for exercises or activities, poor acceptance psychologicallyand leads to physicians rejection as a brace for scoliosis