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Spinal Supports and Elastic Binders
Spinal Corsets
Cervical Orthoses(CO)
Cervical Traction Orthoses
Cervical Thoracic Orthoses (CTO)
Cervical-Thoraco-Lumbo-Sacral Orthoses (CTLSO)
Thoraco-Lumbo-Sacral Orthoses (TLSO)
Lumbo-Sacral Orthoses (LSO)
Thoraco-Lumbo-Sacral Hip Orthoses (TLSHO)
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Spinal Orthoses: Spinal orthoses are divided into flexible and rigid supports. They are also defined according to which portion of the vertebral column they stabilize. Therefore a CO is a cervical orthosis and a TLSO would be a thoraco-lumbo-sacral orthosis. Each type of orthosis is effective on specific areas of the spine.
The spine can be likened to a slinky. When one segment of the spine moves it creates motion above and below it. Due to this inherent motion when treating the spine it is necessary to treat both above and below the involved area.
Spinal Supports and Elastic Binders
- Flexible Spinal Supports: Flexible spinal supports are primarily used to aid in abdominal compression, restriction of motion, muscle relaxation, and postural realignment. Elastic binders with rigid posterior panels or corsets are offered in different variations for treatment of the thoracic, lumbar, and sacral spine. (Fig.1)
- Elastic Binders with Rigid Posterior Panels: Elastic binders are effective in aiding in abdominal compression, muscle relaxation, some restriction of motion, and postural realignment. Often they have a rigid posterior panel that is inserted into a pocket in the back of the orthosis. The panel is heated and molded to the patient’s back. This creates a rigid posterior panel that helps to restrict motion and to provide additional support. (Fig.2)
Indications:
Low back pain
Disc herniations
Post-operative use
Neurofibromatosis
Multiple sclerosis
Spinal cord injuries
Spinal Corsets
- Corsets: These orthoses utilize a fabric construction with stays (plastic, metal, springs) to give additional support and help reduce excessive motion of the spine. The stays are customized to fit the patient and to aid in postural realignment. (Fig.3)
Indications:
Low back pain
Disc herniations
Post-operative use
Neurofibromatosis
Multiple sclerosis
Spinal cord injuries
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Cervical Orthoses
- Halo Orthoses: Halo orthoses are used to treat injuries to the cervical spine. This orthosis is comprised of a vest and superstructure (Fig.1), halo ring, and skull pins (Fig.2). Halo pins pierce the skin and penetrate the outer layer of the Periosteum (the outer layer of bone). They do not penetrate the skull. The halo ring is attached to a superstructure that is used for attachment and stabilization to the thoracic vest. The vest must fit very intimately with the patient; if there is movement of the vest this can translate to motion of the cervical spine, a contraindication for treatment of fractures. The pin sites should be cleaned twice daily to avoid infection and the patient should use sponge bathing to clean his lower extremity and arms. The thoracic portion of the body is cleaned using a small towel with rubbing alcohol and feeding it between the patient and the vest. This technique will maintain the stability of the orthoses, maintain the alignment of the fractures and avoid having soapy buildup on the patient's skin. The patient should never adjust the vest, superstructure, and halo; any adjustments should be done under the supervision of a physician.
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Cervical Orthoses (COs): There are many different designs of collars ranging from soft collars used to treat whiplash and muscular strains to rigid collars that are used to treat fractures and for post-operative stabilization.
- Soft Collar: This orthosis is usually manufactured from soft foam and is used to give support and stability to the cervical spine. (Fig.3)
Indications:
Whiplash
Muscular strains/sprains
Post CTO/Halo management
- Rigid Collar: There are several styles of rigid cervical orthoses. Some are fabricated with two pieces of Velcro on each side while others are one piece that wrap around the neck secured with one strap. Each combine a rigid plastic shell and soft removable lining. Rigid collars are effective in reducing motion, providing stability and support to the cervical spine. (Fig.4)
Indications:
Cervical fractures
Muscular injuries
Degenerative joint disease
Rheumatoid arthritis
Ankylosing spondylitis
Nerve impingement
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Cervical Traction Orthoses: Cervical traction orthoses are designed to provide a distractive force to the cervical spine for treatment of nerve root compression, radiculopathy, and other cervical pathologies.These are usually not worn full time but worn intermittently to provide relief from pain and paresthesis.
- Over the Door Cervical Traction: This orthosis is comprised of a water/sand bag, pulley system and head/neck harness. The patient fills the bag to the appropriate weight then sits against a door with a traction halter with the head acting as a distractive force on their cervical spine. Wearing schedules, amount of distraction, and duration are determined by your physician. (Fig.1-2)
- Pneumatic Cervical Traction Orthosis: This orthosis is designed as a collar with an air bladder that can be pumped up to create a distractive force on the spine. This orthosis can be worn around the house unlike the over the door traction collar. Wearing schedules, amount of distraction, and duration are determined by your physician. (Fig.3)
Indications for both Over the Door and Pneumatic Cervical Traction Orthoses
Nerve root compression
Radiculopathy
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Rigid Cervical Thoracic Spinal Orthoses(CTO): These orthoses are used when maximum motion restriction is warranted for treatment of fractures, post-operative stabilization, spinal cord injuries, and other pathologies of the spine. The biomechanical principals of these orthoses are restriction of motion, realignment, stabilization and protection.
Cervical-Thoracic Orthoses (CTOs): These orthoses often referred to as a Minerva brace and are often manufactured from a hard plastic shell and lined with a soft interface. They incorporate a mandibular (chin) and occipital (posterior head) section for additional spinal control. (Fig.4)
Indications:
Cervical and high thoracic fractures
Muscular injuries
Degenerative joint disease
Rheumatoid arthritis
Ankylosing spondylitis
Nerve impingement
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Cervico-Thoraco-Lumbo-Sacral Orthoses (CTLSO): CTLSOs are effective in treating levls C3-L3/4 of the vertebral column. This orthosis stabilizes areas of the thoracic spine where CTO's are ineffective. This orthosis is also often used if there are multiple levels of involvement. (Fig.1)
Indications (C3-L3/4):
Fractures
Muscular injuries
Degenerative joint disease
Rheumatoid arthritis
Ankylosing spondylitis
Nerve impingement
Thoraco-Lumbo-Sacral Orthoses (TLSO): TLSOs or body jackets are fabricated effective for treating thoracic and sacral vertebrae from levels of T7/8-L3-4. They are typically fabricated from hard plastic with a soft interface.
There are several variations of these orthosis; some are one piece (wrap-around) while others are a bi-valve (two piece) construction. (Fig.2)
Indications:
Thoracic and lumbar fractures
Muscular injuries
Degenerative joint disease
Rheumatoid arthritis
Nerve impingement
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Cruciform: This style of orthosis is effective for treatment of the low thoracic and high lumbar spine. The orthosis is named for the cross like shape that is formed by the vertical and horizontal uprights. This orthosis is often recommended for treatment of anterior compressions fractures secondary to trauma and osteoporosis. (This orthosis is also known as a C.A.S.H. cruciform anterior sternal hyperextension orthosis) (Fig.3)
Indications:
Thoracic and lumbar fractures (Anterior compression fractures)
Muscular injuries
Degenerative joint disease
Osteoporosis
- Jewett Orthosis: The functionality of the Jewett orthosis is very similar to the cruciform orthosis. It is effective for treatment of vertebral fractures, injuries and post-operative stabilization of the thoracic and lumbar spine. The Jewett orthosis has lateral uprights and pads that provide additional stability and limits lateral flexion of the spine.
Indications:
Thoracic and lumbar fractures (Anterior compression fractures)
Post-operative stabilization
Degenerative joint disease
Osteoporosis
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Lumbo-Sacral Orthosis (LSO): LSO's are effective for treatment of the low thoracic and lumbar spine. Typically fabricated from hard plastic with a soft interface, they can be constructed as one-piece (wrap-around) styles or a bi-valve (two piece) style. (Fig.3)
Indications:
Lumbar fractures (may be effective for low thoracic fractures/injuries
Muscular Injuries
Degenerative joint disease
Nerve impingement
Pelvic fractures
Sacral fractures
- Thoraco-Lumbo-Sacral Hip Orthosis (TLSHO/HTLSO): This orthosis incorporates a TLSO with a hip extension. The thigh extension can be integrated or it can be attached via a joint and thigh cuff. This orthosis is effective in treating the low lumbar spine where a TLSO is ineffective, sacral fractures, and pelvic fractures.
Indications:
Thoracic and lumbar fractures (Anterior compression fractures)
Muscular Injuries
Degenerative joint disease
Nerve impingement
Pelvic fractures
Sacral fractures
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