Spinal Orthoses Overview

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Questions and Answers

Which collar is considered statistically superior in limiting cervical motion in all planes?

Philadelphia collar

NecLoc (correct)

Stifneck

Miami J collar

What is a primary use of the halo vest in cervical stabilization?

To provide additional support after surgery (correct)

To restrict motion in all cervical regions

To support patients with minor injuries

To stabilize subaxial spinal trauma

Which collar exerts pressures well below the capillary closing pressure?

Stifneck collar

NecLoc collar

Aspen collar

Miami J collar (correct)

When is the halo vest mostly useful?

After complex surgical reconstructions Signup and view all the answers

Which collar produced excessive pressure at collar-tissue interfaces?

Stifneck collar Signup and view all the answers

What type of fractures is the halo vest considered the treatment of choice for?

Hangman's fractures Signup and view all the answers

The NecLoc and Miami J collars are statistically superior to which collars?

Soft collar and Philadelphia collar Signup and view all the answers

In which condition is the halo vest less frequently used now?

Subaxial trauma Signup and view all the answers

What is the primary goal of using orthoses for thoracolumbar fractures?

To resist anterior flexion Signup and view all the answers

Which brace is suitable for patients with coexisting abdominal trauma or obesity?

Jewett brace Signup and view all the answers

In what range of vertebrae is the Jewett brace most commonly used?

T10 to L2 Signup and view all the answers

What percentage of restriction in lateral bending does a custom-molded thermoplastic TLSO provide in the lumbar spine?

38% Signup and view all the answers

Which of the following is a contraindication for using the Jewett brace?

Thoracolumbar burst fracture Signup and view all the answers

What is a characteristic of the thoracolumbosacral orthosis (TLSO)?

Provides total contact restriction Signup and view all the answers

What is the best design feature of the Jewett orthosis?

Limits trunk flexion while allowing hyperextension Signup and view all the answers

What is a unique challenge posed by lumbosacral immobilization?

Balancing sacral support Signup and view all the answers

What is a key disadvantage of applying significant forces to the cervical spine?

It may cause significant visceral effects. Signup and view all the answers

What is the primary use of soft cervical collars?

To serve as a reminder for limiting exaggerated neck movements. Signup and view all the answers

Which of the following statements about rigid collars is true?

They come in a variety of reinforced types with different motion restrictions. Signup and view all the answers

What is a significant concern when using spinal orthotics?

Comfortable fit is essential to prevent skin problems. Signup and view all the answers

What can soft collars restrict in terms of cervical motion?

Up to 10% restriction in all planes. Signup and view all the answers

What is the purpose of a cervical orthosis that extends distally onto the thoracic cage?

To provide additional control for cervical support. Signup and view all the answers

What can result from the immobilization of muscles due to prolonged use of orthoses?

Soft tissue contractures. Signup and view all the answers

Which of the following is NOT a type of rigid cervical collar?

Cervical support belt. Signup and view all the answers

What is the primary action of spinal orthoses?

To reduce gross spinal motion Signup and view all the answers

What is the purpose of the three-point mold in hyperextension braces?

To prevent progressive kyphotic deformity Signup and view all the answers

Which condition is hyperextension typically used to counter?

Fractured vertebral body under flexion Signup and view all the answers

What physical complications can arise from improper pressure applied by a spinal orthosis?

Skin breakdown and pain Signup and view all the answers

Which of the following is a secondary effect of spinal orthoses?

Stabilization of individual functional spinal units Signup and view all the answers

What characteristic of a brace affects its ability to apply appropriate forces?

The soft tissue envelope in contact areas Signup and view all the answers

How does hyperextension achieved by braces like Jewett and CASH impact a fractured vertebra?

It reduces compressive force and limits distraction Signup and view all the answers

In what plane do corrective braces for scoliosis direct their forces?

Coronal plane Signup and view all the answers

What does adolescent idiopathic scoliosis (AIS) primarily involve?

A curvature and rotational deformity of the spine Signup and view all the answers

What is the purpose of the compensatory curve in AIS?

To keep the head centered over the pelvis Signup and view all the answers

What type of brace is the Milwaukee brace classified as?

Cervicothoracolumbosacral orthosis (CTLSO) Signup and view all the answers

For how many hours daily should the Milwaukee brace ideally be worn?

23 hours Signup and view all the answers

What was one of the main reasons for creating the Boston brace?

To simplify the fitting process for patients Signup and view all the answers

What is a notable feature of the Boston brace compared to the Milwaukee brace?

It requires less time for custom fitting Signup and view all the answers

Which type of spinal curvature is the Milwaukee brace particularly effective for?

Upper thoracic curves Signup and view all the answers

What is a common characteristic of most spinal orthoses mentioned?

They control alignment of the thoracolumbosacral spine Signup and view all the answers

What is the primary function of a lumbar corset?

To provide stabilization and reduce trunk motion Signup and view all the answers

Which spinal levels are commonly associated with the use of a rigid LSO brace?

L2, L3, and L4 Signup and view all the answers

What is a characteristic feature of the Chairback orthosis?

It includes thoracic and pelvic bands connected by paraspinal bars. Signup and view all the answers

How does adding an extension to a brace affect motion at L5-S1?

It adds an additional 15% to 30% reduction in motion. Signup and view all the answers

What is the primary benefit of lumbar corsets for patients with acute low back pain?

They provide psychological reassurance and physical support. Signup and view all the answers

What type of scoliosis is primarily managed with spinal orthoses?

Idiopathic scoliosis. Signup and view all the answers

What is one of the main roles of the Knight orthosis?

To enhance coronal control by having lateral bars. Signup and view all the answers

What is the mean percentage of motion allowed at L4-5 in a brace without extension?

32% Signup and view all the answers

Study Notes

Spinal Orthoses

Spinal orthoses have several common effects on the spinal region they treat. Their primary function is to reduce gross spinal motion, and the effectiveness of this depends on their materials and design.
Secondary effects include stabilization of individual functional spinal units, reducing the range of motion of one vertebra relative to another.
Spinal orthoses apply closed chain forces to counter deforming forces, like providing hyperextension to a fracture vulnerable to flexion.
They reduce spinal loads by preventing specific actions (bending and twisting) to reduce stress on surgical implants.

Braces

Braces help restore or exaggerate natural spine structure.
In clinical practice, thoracolumbar body casts were often used, and patients were positioned supine on a casting table with a lumbar spine belt to achieve hyperextension during casting.

Hyperextension

Hyperextension (hyperlordosis) is used in braces (like Jewett and CASH) to reduce compressive forces on the fractured vertebral body and limit distraction of posterior elements.

Brace Components and Application

Brace components include buckles, straps, and pads.
Application involves specific steps such as unhooking buckles, positioning lumbar pads, wrapping belt, and ensuring snug fit.

Brace Ability and Complications

A brace's ability to apply appropriate forces (stabilizing or corrective) depends on its action on spine structures and surrounding soft tissues.
Too little or too much pressure can lead to complications like skin breakdown, pain, soft tissue contractures, loss of reduction or alignment, and weakening of immobilized muscles.

Regional Orthoses (Cervical)

Complex cervical soft tissues (vessels, airway, esophagus) pose a significant challenge, limiting direct forces applied to the spine.
Cervical spine orthoses are often limited to the subaxial spine, a cylinder fitting the neck with trim lines at occiput, mandible, and sternoclavicular regions. They can extend proximally/distally (halo vest) or distally into the thoracic cage (cervicothoracic orthosis [CTO]).

Soft Collars

Soft collars are the most comfortable cervical collars but offer little stability (up to 10% restriction in all planes).

Rigid Collars

Multiple rigid reinforced collars (Philadelphia, Aspen, Miami J, NecLoc, Stifneck) are available.
Reinforced collars have anterior and posterior shells, inner padding, and Velcro-type fasteners that contour around the neck. They offer end-point control by abutting the sternum, clavicles, upper thoracic spine, mandible, and occiput. Most include respiratory accommodations.

Cervical Stability

Cervical collars' ability to provide stability is crucial (3-25% of spinal cord injuries occur after the initial spine injury).
NecLoc is statistically superior to other collars in limiting cervical motion (especially compared to Philadelphia and Aspen collars).

Halo Vest

Halo vests are used in provisional stabilization of injuries/conditions at the occipitocervical junction, providing additional support after surgery.
They're often used in fractures and dislocations.

Thoracolumbar Orthoses

Thoracolumbar region (T10-L2) is commonly affected by fractures, and orthoses are often used for management to resist anterior flexion and prevent kyphotic deformities.
Optimal management includes a strategy to resist anterior flexion and preclude kyphotic deformity. (Best used for T10-L2 fractures, though some orthoses can accommodate up to T8.)
Common examples of thoracolumbar orthoses are the Jewett Brace and the CASH brace

TLSOs

Thoracolumbosacral orthoses (TLSO) provide total contact immobilization of the spine (limiting range of motion in all planes).
Molded TLSOs (custom-designed) show high efficacy in restricting lumbar spine lateral bending and flexion/extension (over 90%).

Lumbar Corsets

Lumbar corsets are a support for back pain reduction. They minimize trunk motion and increase intracavitary pressure. A three-point pressure system works on the lumbar spine.
Corsets are useful for postoperative patients with poor bone health, to enhance healing.

Chairback Orthosis

Chairback orthoses combine a pelvic band, thoracic band, and two paraspinal bars to manage sagittal control.

Scoliosis

Scoliosis is a three-dimensional spinal deformity involving coronal displacement of vertebral bodies and abnormal vertebral rotation.
Adolescent idiopathic scoliosis (AIS) is the most frequently managed type with spinal orthosis.

Milwaukee Brace

The Milwaukee brace is a cervicothoracolumbosacral orthosis; it's been used post-surgically, and for cases without surgery.

Charleston Nighttime Brace

The Charleston Nighttime Brace is designed for maximal curve correction while the patient sleeps. Correction levels can cause discomfort in upright positions.

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Description

This quiz covers the essential concepts of spinal orthoses and their impacts on spinal motion and stabilization. It discusses the design, function, and therapeutic uses of various braces, including the technique of hyperextension. Test your knowledge on how these devices are pivotal in managing spinal conditions.