L4 Spinal Orthotics

Question 1

Goals of Spinal Orthoses

Answer 1

1. limit motion to reduce pain, protect unstable segments, or facilitate healing following injury/surgery
2. support the trunk or neck to reduce loads applied to spine during functional activities
3. Correct or limit the progression of deformity
4. provide a reminder to the wearer to maintain or initiate active postural corrections
5. alignment of spinal skeletal structures
6. reduction of axial loading through spine
7. increasing intra-abdominal pressure may reduce axial loading

Question 2

Spinal orthoses DO NOT

Answer 2

apply forces to assist movement or substitute for missing muscle function

Question 3

Cervical Orthoses

Answer 3

support spine’s muscular and bony structures

soft or hard, depends on if you want to restrict or allow movement

Question 4

Cervical orthoses are used for

Answer 4

control of unwanted cervical flexion, extension, rotation

after trauma, acute pain, spinal stenosis

Question 5

Soft Cervical Collar

Answer 5

soft foam material with velcro strap

cannot significantly restrict cervical spine ROM

provides partial support of head reducing para-spinal contraction and spasm

recommended use less than 2 weeks

Question 6

Uses of soft cervical collar

Answer 6

used to manage muscle pain and spasms such as spondylosis, minor trauma like whiplash

Question 7

Hard Cervical Collars

Answer 7

rigid or semi rigid

main function is support, limits motion in all planesT

Question 8

types of hard cervical collar

Answer 8

miami j collar
VISTA collar
aspen
headmaster
philadelphia

Question 9

Indications for hard cervical collars

Answer 9

1. cervical trauma in unconscious pt
2. jefferson’s fracture
3. traumatic spondyloisthesis of C2 on C3
4. dens type 1 fracture
5. post-op care
6. anterior discectomy
7. cervical strain

Question 10

Philadelphia Collar

Answer 10

greater ability to limit movement compared to the soft collar

large hole in the front is designed to accommodate a tracheostomy. also used for postsurgical stabilization

provides slight load reduction

Question 11

Cervicothoracic Orthosis Types

Answer 11

halo
sterno-occipital mandibular orthosis
minerva

Question 12

Halo

Answer 12

-surgically applied by pins which are placed in cranial table with jacket fitted to torso
-more effective than hard collar at restricting motion

Question 13

Indications for Halo

Answer 13

presurgical correction
post op fusion support
alternative to surgery

Question 14

Minerva

Answer 14

removable version of the halo

offers control of motion down to T3

Question 15

Indications of Minerva

Answer 15

-mid to lower cervical spine injuries
-stable upper cervical spine injuries
-can be used with skull fractures when a halo would be contraindicated
-peds due to decreased weight/improved comfort

Question 16

Cervico-thoracolumbosacral orthosis CTLSO

Answer 16

post-operative cervical fusions
a/p control of cervical spine
high compression fractures
osteoporosis
herniated cervical disc
spinal trauma

Question 17

Thoracolumbosacral orthosis

Answer 17

Off the shelf = cash, jewett
custom molded

Question 18

TLSO Indications

Answer 18

post op fusion
kyphosis
compression fx
osteoporosis
burst fx
spinal stenosis
spinal muscular atrophy
laminectomy
spinal trauma

Question 19

CASH Brace

Answer 19

used for cruciform anterior spinal HE

provides flexion control for the lowe rthoracic and lumbar regions via the three point pressure system

Question 20

Forces of CASH Brace

Answer 20

post directed forces through sternal and suprapubic pads

anteriorly directed force applied through a thoracolumbar pad

Question 21

Jewett Orthosis

Answer 21

limits spinal flexion

reduces discomfort associated with compression fx, degenerative disc disease, kyphosis, osteoporosis, OA

Question 22

Indications for bracing in scoliosis

Answer 22

flexible curves with cobb’s angle 10-40°

> 40° indicates surgery
30-40° use of orthosis
10-20° observe

Question 23

Orthopedists typically recommend bracing for scoliosis for peds..

Answer 23

who are still growing and have a curvature ≥ 25°

Question 24

Goal of scoliosis brace

Answer 24

its to keep the curve from progressing to the level taht surgery is required

some pts achieve curve reduction with bracing

Question 25

Boston brace

Answer 25

3 point pressure system
cuts outs to allow body to move
difficult to control rotation

Question 26

Cheneau Brace

Answer 26

relatively new with limited research

fully custom made

controls rotation with extension at shoulders

Question 27

Indications of LSO

Answer 27

post op
degenerative disc disease
spondyloysis
spinal stenosis
compression fx
herniated disc
pain relief
postural support
reduces lumbar lordosis
vasomotor and respiratory support
increases abdominal pressure

Question 28

Types of LSO

Answer 28

soft fabric lumbar support
molded plastic

Question 29

Post surgical spinal orthoses

Answer 29

surgeon post op orders specify wear time, how to wear, etc

logroll technique technique to don brace in bad

Question 30

Spinal fusion

Answer 30

should be wearing spinal orthosis for up to 3 months

dictated by surgeons preference