Podcast
Questions and Answers
Which collar is considered statistically superior in limiting cervical motion in all planes?
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?
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?
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?
When is the halo vest mostly useful?
Which collar produced excessive pressure at collar-tissue interfaces?
Which collar produced excessive pressure at collar-tissue interfaces?
What type of fractures is the halo vest considered the treatment of choice for?
What type of fractures is the halo vest considered the treatment of choice for?
The NecLoc and Miami J collars are statistically superior to which collars?
The NecLoc and Miami J collars are statistically superior to which collars?
In which condition is the halo vest less frequently used now?
In which condition is the halo vest less frequently used now?
What is the primary goal of using orthoses for thoracolumbar fractures?
What is the primary goal of using orthoses for thoracolumbar fractures?
Which brace is suitable for patients with coexisting abdominal trauma or obesity?
Which brace is suitable for patients with coexisting abdominal trauma or obesity?
In what range of vertebrae is the Jewett brace most commonly used?
In what range of vertebrae is the Jewett brace most commonly used?
What percentage of restriction in lateral bending does a custom-molded thermoplastic TLSO provide in the lumbar spine?
What percentage of restriction in lateral bending does a custom-molded thermoplastic TLSO provide in the lumbar spine?
Which of the following is a contraindication for using the Jewett brace?
Which of the following is a contraindication for using the Jewett brace?
What is a characteristic of the thoracolumbosacral orthosis (TLSO)?
What is a characteristic of the thoracolumbosacral orthosis (TLSO)?
What is the best design feature of the Jewett orthosis?
What is the best design feature of the Jewett orthosis?
What is a unique challenge posed by lumbosacral immobilization?
What is a unique challenge posed by lumbosacral immobilization?
What is a key disadvantage of applying significant forces to the cervical spine?
What is a key disadvantage of applying significant forces to the cervical spine?
What is the primary use of soft cervical collars?
What is the primary use of soft cervical collars?
Which of the following statements about rigid collars is true?
Which of the following statements about rigid collars is true?
What is a significant concern when using spinal orthotics?
What is a significant concern when using spinal orthotics?
What can soft collars restrict in terms of cervical motion?
What can soft collars restrict in terms of cervical motion?
What is the purpose of a cervical orthosis that extends distally onto the thoracic cage?
What is the purpose of a cervical orthosis that extends distally onto the thoracic cage?
What can result from the immobilization of muscles due to prolonged use of orthoses?
What can result from the immobilization of muscles due to prolonged use of orthoses?
Which of the following is NOT a type of rigid cervical collar?
Which of the following is NOT a type of rigid cervical collar?
What is the primary action of spinal orthoses?
What is the primary action of spinal orthoses?
What is the purpose of the three-point mold in hyperextension braces?
What is the purpose of the three-point mold in hyperextension braces?
Which condition is hyperextension typically used to counter?
Which condition is hyperextension typically used to counter?
What physical complications can arise from improper pressure applied by a spinal orthosis?
What physical complications can arise from improper pressure applied by a spinal orthosis?
Which of the following is a secondary effect of spinal orthoses?
Which of the following is a secondary effect of spinal orthoses?
What characteristic of a brace affects its ability to apply appropriate forces?
What characteristic of a brace affects its ability to apply appropriate forces?
How does hyperextension achieved by braces like Jewett and CASH impact a fractured vertebra?
How does hyperextension achieved by braces like Jewett and CASH impact a fractured vertebra?
In what plane do corrective braces for scoliosis direct their forces?
In what plane do corrective braces for scoliosis direct their forces?
What does adolescent idiopathic scoliosis (AIS) primarily involve?
What does adolescent idiopathic scoliosis (AIS) primarily involve?
What is the purpose of the compensatory curve in AIS?
What is the purpose of the compensatory curve in AIS?
What type of brace is the Milwaukee brace classified as?
What type of brace is the Milwaukee brace classified as?
For how many hours daily should the Milwaukee brace ideally be worn?
For how many hours daily should the Milwaukee brace ideally be worn?
What was one of the main reasons for creating the Boston brace?
What was one of the main reasons for creating the Boston brace?
What is a notable feature of the Boston brace compared to the Milwaukee brace?
What is a notable feature of the Boston brace compared to the Milwaukee brace?
Which type of spinal curvature is the Milwaukee brace particularly effective for?
Which type of spinal curvature is the Milwaukee brace particularly effective for?
What is a common characteristic of most spinal orthoses mentioned?
What is a common characteristic of most spinal orthoses mentioned?
What is the primary function of a lumbar corset?
What is the primary function of a lumbar corset?
Which spinal levels are commonly associated with the use of a rigid LSO brace?
Which spinal levels are commonly associated with the use of a rigid LSO brace?
What is a characteristic feature of the Chairback orthosis?
What is a characteristic feature of the Chairback orthosis?
How does adding an extension to a brace affect motion at L5-S1?
How does adding an extension to a brace affect motion at L5-S1?
What is the primary benefit of lumbar corsets for patients with acute low back pain?
What is the primary benefit of lumbar corsets for patients with acute low back pain?
What type of scoliosis is primarily managed with spinal orthoses?
What type of scoliosis is primarily managed with spinal orthoses?
What is one of the main roles of the Knight orthosis?
What is one of the main roles of the Knight orthosis?
What is the mean percentage of motion allowed at L4-5 in a brace without extension?
What is the mean percentage of motion allowed at L4-5 in a brace without extension?
Flashcards
What is the primary role of spinal orthoses?
What is the primary role of spinal orthoses?
A spinal orthosis's primary function is to restrict excessive spinal movement.
How do spinal orthoses affect individual vertebrae?
How do spinal orthoses affect individual vertebrae?
Spinal orthoses stabilize functional units of the spine, reducing movement between vertebrae.
What kind of forces do spinal orthoses apply?
What kind of forces do spinal orthoses apply?
Spinal orthoses apply forces to counteract deforming forces, often used to prevent further damage from fractures.
How do orthoses protect the spine itself?
How do orthoses protect the spine itself?
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What is another key effect of spinal orthoses?
What is another key effect of spinal orthoses?
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Explain hyperextension in spinal orthoses.
Explain hyperextension in spinal orthoses.
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What is a three-point mold?
What is a three-point mold?
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What are some potential complications of using a spinal orthosis?
What are some potential complications of using a spinal orthosis?
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Soft tissue contractures
Soft tissue contractures
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Loss of reduction or spinal alignment
Loss of reduction or spinal alignment
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Weakening of the immobilized muscles
Weakening of the immobilized muscles
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Spinal Orthotic
Spinal Orthotic
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Cervical Orthotic
Cervical Orthotic
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Soft Collar
Soft Collar
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Rigid Collar
Rigid Collar
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Cervicothoracic Orthotic (CTO)
Cervicothoracic Orthotic (CTO)
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NecLoc Collar
NecLoc Collar
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Miami J Collar
Miami J Collar
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Philadelphia Collar
Philadelphia Collar
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Stifneck Collar
Stifneck Collar
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Anterior Body Fracture
Anterior Body Fracture
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Kyphosis
Kyphosis
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Halo Vest
Halo Vest
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Burst Fracture
Burst Fracture
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Hangman's Fracture
Hangman's Fracture
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Orthosis
Orthosis
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Subaxial Cervical Fracture
Subaxial Cervical Fracture
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Cervical Stability
Cervical Stability
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Hyperextension Orthosis
Hyperextension Orthosis
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Jewett Brace
Jewett Brace
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Cruciform Anterior Spinal Hyperextension Brace (CASH)
Cruciform Anterior Spinal Hyperextension Brace (CASH)
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Thoracolumbosacral Orthosis (TLSO)
Thoracolumbosacral Orthosis (TLSO)
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Lumbosacral junction
Lumbosacral junction
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Lumbar corset
Lumbar corset
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LSO (Lumbar Sacral Orthosis)
LSO (Lumbar Sacral Orthosis)
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Chairback orthosis
Chairback orthosis
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Knight orthosis
Knight orthosis
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Scoliosis
Scoliosis
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Idiopathic scoliosis
Idiopathic scoliosis
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Spinal orthoses for scoliosis
Spinal orthoses for scoliosis
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Adolescent Idiopathic Scoliosis (AIS)
Adolescent Idiopathic Scoliosis (AIS)
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Primary Curve
Primary Curve
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Compensatory Curve
Compensatory Curve
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Milwaukee Brace
Milwaukee Brace
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Pelvic Section
Pelvic Section
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Superstructure
Superstructure
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Boston Thoracolumbosacral Orthosis (Boston Brace)
Boston Thoracolumbosacral Orthosis (Boston Brace)
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Rigid Underarm Thoracolumbosacral Orthosis (TLSO)
Rigid Underarm Thoracolumbosacral Orthosis (TLSO)
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Study Notes
Spinal Orthoses
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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.
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Secondary effects include stabilization of individual functional spinal units, reducing the range of motion of one vertebra relative to another.
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Spinal orthoses apply closed chain forces to counter deforming forces, like providing hyperextension to a fracture vulnerable to flexion.
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They reduce spinal loads by preventing specific actions (bending and twisting) to reduce stress on surgical implants.
Braces
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Braces help restore or exaggerate natural spine structure.
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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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