Spinal Orthotics

Question 1

3 types of cervical/cervicothoraic orthoses

Answer 1

Collars
Poster-type
Halo- and Minerva-types

Question 2

Describe a soft collar

Answer 2

Made from thermoplastic foam or rubber covered by cotton stocking. Degree of support provided depends on the compressibility of the material it is made from

Question 3

Describe a firm collar

Answer 3

Pre-fabricated or custom made. Provide greater mandible and occipital support. More rigid therefore a more effective restraint than soft collars

Question 4

Examples of firm collar devices

Answer 4

Supra-Lite and the Philadelphia collars

Question 5

How does the Yale collar design differ

Answer 5

It has distal anterior and posterior extensions which increase control of cervical flexion and extension

Question 6

Uses of collars

Answer 6

Whiplash
Arthritis
Stable bone/ligamentous injuries

Question 7

Benefits of collars

Answer 7

Act as a reminder to self-restrict motion
Keeps the neck warm
Provides psychological support
Easy to fabricate at low cost

Question 8

Disadvantages of collars

Answer 8

Only provide limited control over cervical motion

Limited head support

Question 9

What are poster-type orthoses

Answer 9

Cervical/Cervicothoracic collars with 2 or more uprights that extend from the thoracic component to the occipital and mandible areas

Question 10

What are poster-type orthoses used for

Answer 10

Stable bony/ligamentous/soft tissue injuries to the mid and lower cervical spine
May be used after removal of halo-top orthosis

Question 11

Give an example of a 3-poster device

Answer 11

Sterno-occipital mandibular immobiliser (SOMI) brace

Question 12

What restrictions does the SOMI impose

Answer 12

Most effective at resisting head flexion

Some resistance to head extension and lateral rotational control

Question 13

Which movements are a 4 poster orthoses least effective at restraining

Answer 13

Head rotation: head can slide on the mandible and occipital pads
Lateral head movement: because some movement between the mandible and occipital pads can occur

Question 14

Benefits of poster orthoses

Answer 14

Unlike collars, the neck is exposed which is desirable in the presence of wound/surgical incision sites on the neck

Question 15

Describe a halo-top spinal orthosis

Answer 15

Rigid spinal orthosis that is attached firmly to the skull by screws above eye level, connected to the thoracic/thoracolumbar component by 4 rigid uprights

Question 16

How does the Minerva-type spinal orthosis differ from the Halo-type

Answer 16

Has a rigid one-piece posterior section which connects the halo to the thoracic component
The rigid moulded ant. section extends to the chin

Question 17

What are Halo- or Minerva-type spinal orthoses used for

Answer 17

Unstable fractures of the cervical spine: they offer the greatest degree of constraint

Question 18

List some problems of wearing Halo-/Minerva- orthoses over a prolonged period of time

Answer 18

Skin irritation
Muscle atrophy
Joint stiffness
Psychological disorders

Question 19

What are the classifications used for orthoses other than cervical/cervicothoracic orthoses

Answer 19

Dynamic
Postural functional
Postural static

Question 20

When are dynamic spinal orthoses used

Answer 20

When correction of deformity/prevention of progression are required e.g. idiopathic scoliosis and adolescent kyphosis

Question 21

Aims of using dynamic spinal orthoses

Answer 21

Prevent progression of deformity
Minimise structural deformity
Prevent high compressive vertebral stress
Improve/maintain respiratory function

Question 22

How is the neck and head kept centred above the pelvis

Answer 22

Positioning of the pelvic and neck ring portions of the orthosis

Question 23

Give an example of a dynamic spinal orthosis

Answer 23

The Milwaukee CTLSO: 2 post. and 1 ant. metal uprights that connect the moulded pelvic girdle to the cervical ring around the neck. Thoracic and axillary pads attach to the uprights to correct scoliotic curves by 3-point loading

Question 24

How does the Scheuermann TLSO differ from the Milwaukee

Answer 24

Has lateroposterior thoracic panels to correct the spinal kyphosis

Question 25

Describe the Boston TLSO

Answer 25

Straight thermoplastic mould with corrective pads fixed to the inner surface

Question 26

When are postural functional spinal orthoses used

Answer 26

``` Pathologies that require pain relief: Kyphosis from senile osteoporosis Prolapsed IV discs Lower back pain Sciatica Ank spon ```

Question 27

Objectives of postural functional orthoses

Answer 27

Reduce vertebral motion/deformity | Prevent pain

Question 28

Give examples of postural functional orthoses

Answer 28

Jewitt TLSO, Jones TLSO and Raney flexion brace

Question 29

Describe a Jewitt TLSO

Answer 29

Anterolateral torso frame with rotating sternal pad, rigid suprapubic pad and a thoracolumbar strap and pad Primarily controls flexion

Question 30

Describe the Raney flexion brace

Answer 30

A rigid plastic shell which completely surrounds the trunk. An indented region creates abdo compression

Question 31

What is the Raney flexion brace prescribed for

Answer 31

Lumbar sprain Acute sciatica Recurrent/post-op back pain

Question 32

Disadvantages of Raney flexion brace

Answer 32

Uncomfortable to wear | Not suitable for patients who cant tolerate increased abdo pressure

Question 33

What are postural static spinal orthoses used for

Answer 33

Pathologies caused by neuromuscular deficiency Prevent further deformity rather than correcting it E.g. spinal muscle atrophy, DMD, cerebral palsy and polio

Question 34

How to postural static spinal orthoses support mass loads

Answer 34

Apply principle of Total Contact: maximise surface area contact to the wearers body

Question 35

What are some problems with postural static spinal orthoses

Answer 35

Reduction in forced vital capacity

Question 36

Give 2 examples of postural static orthoses

Answer 36

Calot TLSO | Boston Overlap Orthosis

Question 37

Describe a Boston overlap orthosis

Answer 37

``` Rigid thermoplastic module with ant. positioned straps Restrains sagittal and coronal lumbar movement ```