Spinal Orthoses (อุปกรณ์พยุงกระดูกสันหลัง)

Principles of Spinal Bracing

Orthoses = Externally applied devices that apply reactive force to the spine for correcting or preventing deformity, stabilization, unloading, or supportive effects (e.g., massage, warmth, psychological comfort)

Nachemson AE. Orthotic treatment for injuries and diseases of the spinal column. Arch Phys Med Rehabil. 1987;1:11-24.
The most common element among these goals is motion restriction.

 

Spine as a Column

The manner by which orthoses exert restrictive effects is perhaps best understood in terms of column mechanics. Several authors have described the spine as a complex variant of an ideal column with a fixed base and free upper end.2,6 As a theoretic structure, an “ideal” column is considered a homogeneous rod of constant composition, length, and cross-sectional area. Its behavior when loaded by a balanced axial
force has been described mathematically by Euler’s relationship for long-segment column dynamics:

Euler’s relationship for long-segment column dynamics. P = magnitude of the applied axial load, E = modulus of elasticity of the column material, A = cross-sectional area of the column, L = length

White AA, Panjabi MM. Clinical biomechanics of the spine. Philadelphia: Lippincott-Raven; 1978.
Elastic buckling of an ideal column of length L under an axial load P.
This column has failed by buckling because P exceeds the critical load for this column as given by Euler’s relationship, where E is the modulus of elasticity for the column material, A is the cross-sectional area of the column, and L is the length.

 

 

 

 

Prototype spinal orthosis consisting of at least two end-stabilizing elements, such as circumferential bands, and an interconnecting longitudinal upright.

 

 

 

Three-point bending strategies of orthoses utilize two horizontal end forces, Fe, which are balanced by a third oppositely directed force and Fa, at or near the axis of rotation for the column.

This effectively segments the column into two shorter columns, increasing their respective axial load-bearing capacities.

 

 

 

 

[ Cervical orthoses ]

Soft collar

ข้อให้

  • Neck pain จาก muscle spasm

ความสามารถ (Vives et al., 2011)

  • ลด flexion-extension ได้ 5-15%
  • ลด lateral bending ได้ 5-10%
  • ลด rotation 10-17%

ข้อดี

  • เป็น Psychological reminder

การใส่

  • วัดระยะจากคางถึง sternal notch เอาไปเทียบกับ size ที่มี

 

Cervico-thoracic orthoses (CTOs)

ข้อให้

  • ต้องการ limit ROM ของ lower C-spine ถึง T5 จึงต้อง

Choices

  • Sternal-Occipital-Mandibular-Immobilizer (SOMI) brace
  • Minerva device
  • Halo vest
  • Lerman brace

 

TLSO

ความสามารถ

  • prevent flexion-extension T7-L4

Choices

Taylor VS Knight-Taylor orthoses

  • Biomechanics: provide control of flexion, extension, and a minimal amount of axial rotation by means of the three-point pressure systems for each direction of motion
  • Flexion is controlled by the posteriorly directed forces applied through the axillary straps and the abdominal apron and an anteriorly directed force through the paraspinal uprights
  • Design: Knight-Taylor brace มีส่วนประคองที่เอวออกมาด้านข้างมากกว่า จึงควบคุม rotation และ lateral bending ได้มากกว่า Taylor brace (The design of the Taylor consists of a posterior pelvic band extending past the midsagittal plane and across the sacral area. Two paraspinal uprights extend to the spine of the scapula. An apron front extends from the xiphoid to just above the pubic area. There are straps extending from the top of the posterior uprights around the posterior axillary to the scapular bar and forward to the apron. Other straps extend from the paraspinal uprights to the apron.

    The Knight-Taylor has an additional thoracic band that extends from the uprights just below the inferior angle of the scapula to the midsagittal plane and a lateral upright on each side that connects the pelvic band and the thoracic band. These bands provide additional lateral support and motion control to the trunk.)

หักต่ำกว่า L3 ไม่ต้องดาม thoracic portion ใช้แค่ LS orthosis ก็พอ

 

TL hyperextension orthoses

ข้อให้

  • Traumatic/Osteoporotic compression fracture T10-L2
  • ถ้าหักถึง T8 ต้องปรับ sternal pad ขึ้นไปเหนือจากเดิม

Jewett Hyperextension Thoracolumbosacral Orthosis (TLSO)
(aka. Jewett Brace)

Jewett brace

  • กายอุปกรณ์เสริมกรณีที่บริเวณส่วนหน้าของกระดูกสันหลังได้รับบาดเจ็บ (used primarily for the treatment of mild compression fractures of the lower thoracic and thoracolumbar regions)
  • ข้อดี: ใส่นอนได้
  • Biomechanics: จำกัด flexion ของ TL spine ด้วยการจัดให้อยู่ในท่า extension ตลอดเวลา (provides flexion control for the lower thoracic and lumbar regions)
  • This is done with a three-point pressure system consisting of posteriorly directed forces through a sternal and suprapubic pad and an anteriorly directed force applied through a thoracolumbar pad attached to a strap that extends to the lateral uprights
  • ส่วนประกอบ
    1. Sternal plate (แผ่นโลหะที่ยันหน้าอก)
    2. Suprapubic plate (แผ่นโลหะเหนือหัวหน่าว)
    3. Dorsolumbar plate (แผ่นโลหะข้างต้นจะยันกับแผ่นโลหะทางด้านหลังนี้)

 

Three-point pressure system

 

Jewett เหมาะกับ T10-L2

 

Body Jacket

Body Jacket. The thoracolumbar orthosis, or body jacket, is the most rigid brace and is effective from T7 through L4.

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