1. Spinal Orthotics
Dr. Mohamed Taha
Orthopedic Registrar
King Fahad Hospital-Madinah
KSA

2. “A spinal orthotic device is an
external apparatus applied to the body
to limit the motion of, correct
deformity in, reduce axial loading on,
or improve the function of a
particular spinal segment of the
body”.

3. History
• 5,000 years ago ,nearly, Ancient Egyptians
used first splints.
• Middle Ages armorers manufactured splints
that protected as well as stabilized the body.
• Late 16th century french surgeon Ambroise
Pare` developed metal corsets.

4. • Late 17th century Lorenz Heister is credited
with developing the first spinal orthosis quite
similar to the modern day Halo brace.
• Basic principles of spinal immobilization
actually changed a little in past 300 years,
however materials used and combination of
surgery and bracing has changed
tremendously.

5. Spine Biomechanics
• Transfers load from
head & trunk to pelvis.
• Protects spinal cord.
• Permits motion in
three planes.
• Vertebral bodies
progressively larger in
size caudally to sustain
increasing
superimposed weight.

6. 3 flexible curves.
Axial Compression
Resistance =
(number of curvature)2+1.
10 times than straight column.
Stability depends on
loading magnitude &
direction.

7. Intrinsic Stability:
Intervertbral
disc+surrounding
ligaments.
Extrinsic Stability:
muscles
Due to interlocking nature of the spine, certain
types of regional movement are restricted

8. •Intervertbral discs bears
& distributes loads &
restrains excessive
motion.
•Intradiscal pressure is
1.5 times of external
load in compression.
•Stress on lumbar disc:
Supported Reclining
<Upright Standing
<Supported Sitting
<Unsupported Sitting.

9. Intra Abdominal Pressure (IAP)
• IAP rises with forward bending & increasing
load.
• Peak value 100mmgh in lifting heavy object.
• By activation of the muscles stabilizing the
trunk the dorsal directed IAP force preventing
excessive lumbar lordosis under high axial
load.
• Raising IAP reduces the intra-discal pressure
(50% T12-L1 & 30% L5-S1)

10. Spinal Motion

11. Occiput and C1 have significant flexion and
extension with limited side bending and
rotation.

12. C1-C2 complex accounts for 50% of
rotation in the cervical region

13. C2-C4 region has the most side bending & rotation.
C5-C6 region has the greatest amount of flexion &
extension.

14. Limited motion due to Rib Cage.
Little flexion due to oblique orientation of facets.
In caudal direction: lateral bending increases & axial
rotation decrease.
Greatest movement is rotation.

15. •Little rotation due to vertical orientation of facets.
•Greatest movement is flexion & extension.

16. Functions
• Alignment of the spinal skeletal structure.
• Protection of head from impact.
• Reduction of gravitational loading.
• Post-operative immobilization.
• Restriction of motion.
• Prevent progression of deformity.
• Muscle relaxation.
• Pain (back pain).

17. Principals

18. Three-point reaction force can use:
mandible,occiput,sternum,thorax,armpit
,shoulder,back,ribcage &pelvis.
The 1ry method is the three point
pressure system.

19. IAP

20. General Classifications
Flexible Orthotics or Corsets
constructed out of strong fabrics or elastic
materials with a variety of stiffer supports.
Rigid Spinal Orthotics
• Used when greater control of motion or posture
is required.
• Fabricated from high temperature thermoplastics
or light weight metals.
• Wide varieties with a broad selection of pads and
coverings.

21. Cervical Orthoses (Collars)
(1) Soft Collar
Made from soft foam.
Provide mechanical
restraint (5-15%)
Psychologic comfort.
Head support when acute
neck pain occurs.
Relief from minor muscle
spasm.
Relief from cervical strain.

22. (2) Hard collars
Head cervical orthoses (HCO)
•Semirigid and rigid plastics.
•Provide more rigid stabilization of the
cervical spine.
•Include Occiput & Chin to decrease
ROM.
•Used in stable spine conditions.
•Supported chin is a common place for
skin breakdown.
•Clavicle is area HCOs can cause skin
breakdown.
•Long-term use associated with decreased
muscle function and dependency.

23. Philadelphia collar
•Semirigid HCO with a 2-piece
system of Plastazote foam.
• Plastic struts anterior & posterior
used for support.
•Upper portion supports lower jaw
and occiput, lower portion covers
upper thoracic region.
•Anterior hole for a tracheostomy.
•Difficult to clean.
thoracic extension can be added to
increase motion restriction and treat
C6-T2 injuries.

24. Indications:
•Anterior cervical fusion.
•Halo removal.
•Dens type I cervical fractures of C2.
•Anterior diskectomy.
•Suspected cervical trauma in unconscious
patients.
•Most of teardrop fracture of the vertebral
body.
•Cervical strain.

25. Miami J collar
•Semirigid 2-piece
system made of
polyethylene, with a
soft, washable lining
•same indications for
use as those for the
Philadelphia collar.
•thoracic extension
can be added to
increase support and
treat C6-T2 injuries.

26. Malibu collar
•semi-rigid, 2-piece orthosis
•anterior opening for a
tracheostomy.
•indications similar to those for the
Miami J and Philadelphia collars.
•comes in only one size
• adjustable in multiple planes to
ensure proper fit.
•Padding around the chin can be
trimmed to ensure proper fit
• thoracic extension can be added to
increase support and treat C6-T2
injuries.

27. Cervicothoracic orthoses (CTOs)
•greater motion restriction in the middle
to lower cervical spine.
•upper cervical spine has less motion
restriction.
•used in minimally unstable fractures.

28. Sternal-occipital-mandibular immobilizer (SOMI)
• CTO with anterior chest plate
extending to the xiphoid
process & metal or plastic
bars curve over the shoulder.
• Straps from the bars over the
shoulder & cross to opposite
side of the anterior plate for
fixation.
• 2-poster CTOs start from the
chest plate and attach to the
occipital component.
• SOMI is ideal for bedridden
patients because it has no
posterior rods.

29. •removable chin
piece with an
optional headpiece
can be used if chin
piece is removed
for eating.
•Comfortable.
•Proper adjustment
is crucial for
motion restriction.

30. Indication:
•SOMI controls flexion in C1-C3 segments
better than cervicothoracic brace.
•Atlantoaxial instability.
•Neural arch fractures of C2 (flexion causes
instability).

31. Halo cervical orthoses
• Greatest reduction in cervical
mobilization.
• Cranial ring secured to the
skull using four metal pins.
• The ring attached by four
metal bars to a plastic vest
and is worn continuously.
• The estemated reduction in
all cervical motions is 90:95%.
• Ability to provide distracting
forces aid in stabilization &
reducing the load of head on
the cervical spine.

32. Lumbsacral corset (LSO)
 Flexible made from
heavy fabrics with laces
and hooks.
 Designed to limit motion,
maintain three point
pressure system and to
reduce pain.

33. Thoracic-Lumbar-Sacral Corset
•Custom Molded Design Back
Brace
•A Two-piece Foam Lined Plastic
Clamshell Design With Straps.

34. Indications:
• Post-Operative Stabilization of the Spine.
• Lumbar Vertebrae Fractures.
• Chronic Back Pain.
• Slippage of One Vertebrae Over Another
• Stable Lumbar Fractures.

35. Indications:
•Post-Operative Stabilization.
•Unloading Anterior
Compression Fractures.
•Slippage Vertebrae Over
Another.
•Stable Lumbar/Thoracic
Fractures.
Thoracic-Lumbar-Sacral Orthosis
(TLSO)

36. Plastic Body Jacket
•Fabricated with high-temperature
copolymer plastics.
• Well-fitted body jacket restrict
motion in all planes.
•Anterior and lateral trunk
containment elevate intracavitary
pressure.
•Decrease demands on the
vertebral disks.
• Body jackets are frequently used
post surgically or during an acute
trauma.
(flexion-extension-lateral –rotary control)

37. Jewett Hyperextension Brace
Indications :
• Stable spinal
compression fractures
（T7:L2)
without osteoporosis
• Postural kyphosis

38. Milwaukee Brace

39. •Full-torso back brace extends from
the pelvis to base of the skull.
• Designed by Blount & Schmidt in
1946 for prolonged post-operative
immobilization.
•It is more widely used to manage
spinal curvature—e.g., scoliosis or
kyphosis.
•In children who may need to wear
it 23 hours/day for years

40. Advantages:
•Can be molded or adjusted.
•The average 1-year follow
up showed an average 20
percent correction for
thoracic curves.
Disadvantages:
•Must be worn for 12 to 18
months,23 hours a day.
•Rejection due to
psychological issues and
poor acceptance by clients.

41. Drawbacks of Spinal Orthosis
• Discomfort
• Local pain
• Osteopenia
• Skin breakdown
• Nerve compression
• Ingrown facial hair in men
• Muscle atrophy with prolonged use
• Decreased pulmonary capacity
• Difficulty in donning and doffing the orthosis
• Difficulty with transfers
• Psychologic and physical dependency
• Increased segmental motion at the ends of the orthosis
• Unsightly appearance
• Poor patient compliance

42. THANK YOU