Spinal Orthotics
An orthotic device (commonly referred to simply as an orthotic or an orthosis) is an external apparatus that is applied to the body to limit the motion of, correct deformity in, reduce axial loading on, or improve the function of a particular segment of the body.
Design characteristics of an orthosis are crucial to function. The most important features include the following:
* Weight1
* Adjustability
* Functional use
* Cosmesis
* Cost
* Durability
* Material
* Ability to fit patients of various sizes
* Ease with which the device can be put on (donned) and taken off (doffed)
* Provision of access to a tracheostomy site, peg tube, or other drains
* Provision of access to surgical sites for wound care
* Provision of aeration in order to avoid skin maceration from moisture
Indications for recommending the use of orthoses include the following:
* Pain relief
* Mechanical unloading
* Scoliosis management
* Spinal immobilization after surgery
* Spinal immobilization after traumatic injury
* Compression fracture management
* Kinesthetic reminder to avoid certain movements
The duration of orthosis use is determined by the individual situation, as in the following examples:
* In situations where spinal instability is not an issue, the patient should be advised to use the orthosis until he/she can tolerate discomfort without the brace.
* When employed for stabilization after surgery or acute fractures, 6-12 weeks of use should be allowed to permit ligaments and bones to heal.
The use of an orthosis is associated with several drawbacks,2 including the following:
* Discomfort
* Local pain
* Osteopenia
* Skin breakdown3
* Nerve compression
* Ingrown facial hair in men
* Muscle atrophy with prolonged use
* Decreased pulmonary capacity
* Increased energy expenditure with ambulation
* Difficulty in donning and doffing the orthosis
* Difficulty with transfers
* Psychological and physical dependency
* Increased segmental motion at the ends of the orthosis
* Unsightly appearance
* Poor patient compliance
The successful use of an orthosis may lead to any of the following:
* Decreased pain
* Increased strength
* Improved function
* Increased proprioception
* Improved posture
* Correction of spinal curve deformity
* Protection against spinal instability
* Minimized complications
* Healing of ligaments and bones
Physicians must understand the biomechanics of the spine and of each orthosis. The cervical spine is the most mobile spinal segment, with greater flexion 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 side bending and rotation.
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Aug 25, 2008
Shantanu S Kulkarni, DO, Consulting Staff, Department of Physical Medicine and Rehabilitation, Parkview and Lutheran Hospital
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