Spinal Orthoses - Meaning, Aims, Principles, Types, and Complications

What Are Spinal Orthoses?

Spinal orthoses refer to two or more external devices that are used to manage several spinal conditions. An orthosis is a singular form of the word which means straightening. Spinal orthoses are also called back braces. These appliances are used to support the spinal cord and correct the deformities of the spine. There are various types of spinal orthoses available. It was made of metal and leather in the early days. As these materials were uncomfortable, hot, and heavy, nowadays, lightweight foams, thermoplastics, and other materials are used to make them more comfortable. Spinal orthoses work on exerting force on the spinal cord when applied to the body. This may be achieved by two principles: a three-point pressure system and circumferential support.

What Is the Mechanism of Action of Spinal Orthoses?

When applied to the body, spinal orthoses apply forces to the spine. This is achieved through one or a combination of the following methods:

• Three-Point Pressure System: Orthotic devices rely on three-point pressure control, ensuring balanced forces for corrective action. The law of equilibrium mandates equal forces on each side. Tissues vary in pressure tolerance; adjusting lever arm length or contact pad size can mitigate pressure. Orthotics act as lever arms generating corrective forces, with pressure being force divided by area. Increasing lever arm length decreases pressure on bony attachments, enhancing joint control with minimal tissue pressure.

• When encircling the trunk, a spinal orthosis forms a semi-rigid cylinder from the pelvic brim to the lower rib cage, compressing abdominal contents. Studies vary in supporting the reduction of spinal pressure by increasing abdominal pressure. Orthoses may irritate to enforce posture or fixate skeletal segments to limit motion.

What Are the Conditions That Can Be Treated Through Spinal Orthoses?

Conditions that have potentially effective results on orthotic treatment include

• Cervical strain.

• Lumbar strain.

• Radiculopathy.

• Degenerative disc diseases.

• Torticollis.

• Kyphosis.

• Spondylolisthesis.

• Osteoporosis.

• Spondylolysis.

• Post-surgical stabilization.

• Stable fractures

• Inflammatory and non-inflammatory arthritis

• Osteoarthritis.

• Tetraplegia.

What Are the Main Aims of Spinal Orthoses?

Spinal orthoses are used for several purposes in clinical care. The main aims of spinal orthoses are

• Maintaining and stabilizing the spinal alignment.

• Correcting and preventing the deformities of the spine. This will help promote the healing of the fracture and assist in the healing of fixation devices.

• Helps in relieving pain by limiting the range of motion and weight bearing. The spinal orthosis is used to control the sagittal plane of motion, the transverse plane of motion, and the coronal plane of motion.

• Reducing the axial load of the spinal cord. Spinal orthoses help reduce the forces on the spine by elevating the intra-abdominal pressure, increasing the rib cage rigidity, and compressing abdominal muscles.

• Helps in improving functions of the spinal cord.

• Helps in providing kinesthetic feedback and heat by acting as a reminder to the users.

What Is the Classification of Spinal Orthoses?

The spinal orthoses may be classified as

• Supportive Orthoses - These are used for relieving temporary pain by protecting the joints and muscles of the injured part, preventing malformations, and limiting the range of motion that causes pain.

• Corrective Orthoses - These are mostly used in children to treat scoliosis.

• Immobilization Orthoses - These are used to treat spinal trauma and post-spinal reconstruction surgeries.

What Are the Types of Spinal Orthoses?

The types of spinal orthoses are:

1. Cervical Orthosis (CO)

• Soft Collar - The soft cervical collar is the most commonly used cervical collar for assisting with muscular sprains and trauma of the neck or cervical region. It is constructed by using soft foam and coated with cotton wool. It provides minimal support to the head and reduces the spasm and paraspinal contraction. It helps to limit approximately eight to ten percent of cervical movements like flexion, extension, rotation, and lateral bending.

• Hard Collars - These hard collars are rigid or semirigid collars made of hard foam and plastic. Hard collars are mainly used for supporting the cervical region until the surgery treatment is planned. The different types of hard collars are Aspen, headmaster, Philadelphia, Miami J collar, and VISTA collar. The hard collar contains a tracheostomy opening and chin and occiput height adjustment. The main advantage is that it causes less sweating when compared to soft collars. Hard collars are used in unconscious patients with cervical trauma, hangman's fracture, traumatic spondylolisthesis of cervical spine, dens type 1 fracture, cervical strain, anterior discectomy Jeffersons's fracture, and in post-operative care.

2. Cervicothoracic Orthosis (CTO)

The types of cervicothoracic orthosis are:

• Halo - It is the brace that should be applied surgically. Sometimes it can be used as an alternative to surgery to mobilize the neck. It is more efficient than the hard collar in providing limitation to the movements. Halo braces can be indicated in various medical conditions, including sub-axial spine injuries, spinal infections, facet subluxations, odontoid fractures, occipital condyle fractures, etc.

• SOMI (Sterno Occipital Mandibular Orthosis) - SOMI is a removable chain strap with anterior chest plates with three posts that extend to the xiphoid process. It can be used in rheumatoid arthritis and neural arch fractures.

• Minerva - It is a removable type of halo brace. It can be used in cervical spine injuries, especially in the middle to lower part, upper cervical spine injuries, skull fractures, and children, as it is low weight and high comfort.

3. Cervical Thoracic Lumbar Sacral Orthosis (CTLSO)

The classic CTLSO used in the treatment of kyphosis and high thoracic curves is the Milwaukee brace. These are mostly used in correcting curvature of the spine.

4. Throaco Lumbosacral Orthosis (TLSO)

The types of thoracic lumbosacral orthosis include:

• Knight Taylor TLSO.

• CASH.

• Providence night brace.

• Charleston bending brace.

• Body jacket.

• Jewett.

• Off-the-shelf Orthosis - The knight Taylor, Jewett, and CASH are examples of off-the-shelf orthosis. It is designed for high comfort. It is used in lumbar and thoracic spine fractures, the reduction of kyphosis in osteoporosis patients, and unconscious patients with cervical trauma.

• Spinal Jacket - It is used for thoracic compression fractures due to osteoporosis, post-surgical stabilization for spinal fractures, and unstable spinal disorders.

• Custom-Made Spinal Jacket - It is used for night bracing, severe spinal deformities, and scoliosis.

5. Lumbosacral Orthosis (LSO)

This relieves pain, supports posture, supports vasomotor and respiratory systems, and reduces excessive lordosis.

6. Sacral Orthosis (SO)

It is a fabric that is used to treat sacroiliac joint pain.

Conclusion

Spinal orthoses are most commonly used from early times with good results. The various types and designs have evolved with effectiveness in supporting and managing spinal problems. It is most commonly used by older individuals. The prescription of various types of spinal orthoses depends on the problem of the spinal cord. Various problems happen to the spinal cord due to age, trauma, etc. Some of these spinal problems can be treated using spinal orthoses.