CITI ORTHOTIC SERVICES

PARTNERS IN PHYSICAL MEDICINE & REHABILITATION

Spinal Orthotics

Spinal brace (orthotics) is an external device applied onto the trunk to limit motion, correct, reduce axial loading, or improve function in a certain body segment.

Indications for recommend the orthotic device include the following:

-                     Pain relief

-                     Mechanical unloading

-                     Scoliosis management

-                     Spinal immobilization after traumatic injury

            -          Compression fracture  management

            -           Kinesthetic reminder to avoid certain movements

 Duration of orthotic use is determined by the individual situation.

-           In situation where spinal instability is not an issue, recommend use

                        of an orthosis until patient can tolerate discomfort without the brace.

-                     when used for stabilization after surgery or acute fractures, allow 6-12 weeks to permit ligaments and bones to heal.

Certified Orthotist must understand the biomechanics of the spine and each individuals orthosis. The cervical spinal is the most mobile spinal segment with flexion greater than extension. The occiput and C1 have significant flexion and extension with limited side bending and rotation. The C1-C2 complex accounts for 50 % of rotation in the cervical spine.  The C5 – C6 region has the greatest amount of flexion and extension. The C2 –C4 region has the most lateral bending and rotation.

When compared to the cervical spine and lumbar spine, the thoracic spine is the least mobile. The thoracic spine has greater flexion and extension. Lateral bending increases in a caudal direction and axial rotation decreases in caudal direction. The lumbar spine has minimal axial rotation. The greatest movement in the lumbar spine is flexion and extension. Immobilization of the spine increase erector spinae muscle activity since normal rotation occurs with ambulation is limited by the orthosis.

The biomechanical principles in orthotic design include balance of horizontal forces, fluid compression, distraction, construction of a cage around the patient, placement of an irritant serve as a kinesthetic reminder, and skeletal fixation construction of a cage around the patient, like a thoracolumbar brace, increase intra-abdominal forces. Intra-abdominal force converts the soft abdomen into a semi-rigid cylinder, which helps to relieve part of the vertebral loads. In general, structural damage to posterior elements of the spine creates more instability with flexion , whereas damage to anterior elements creates more instability with extension.

Spinal orthoses are generally named by the body regions that they span, For example, CO is a cervical orthosis. CTLSO is a cervico-thoraco-lumbo-sacral orthosis spanning the entire length of the spine, many of these devices are also known by eponyms.

-                     TLSO is thoracolumbosacral orthosis

-                     LSO is lumbosacral orthosis

-                     SO is sacral orthosis