This issue of our newsletter is devoted to orthotic management of spinal disorders. With the vast number of spinal problems and orthotic alternatives available to assist with those problems, exhaustive treatment in a newsletter is obviously not feasible.

Instead, our objective is to present an overview of current-day practice, highlighting the systems that can make a difference for clinicians and patients. We do not necessarily recommend or endorse any of these products for any particular patient or diagnosis but offer them as having significance in certain segments of American practice today.Of necessity, discussion of individual orthosis designs is cursory. If you would like more detailed information, please call our office.

(Note: Due to the wide range and diversity of spinal orthosis designs, this issue will not address devices designed primarily to manage conditions affecting the cervical spine.)

Spinal Bracing Terminology
Categorizing the host of spinal orthosis designs used in contemporary patient rehabilitation can at times be rather
difficult, because (1) there are so many of them, and (2) most can be referred to in several different ways.

Some help was provided by a 1970s task force on standardization of prosthetics-orthotics terminology, which provided a system of nomenclature that describes orthoses in terms of the joints they encompass and the desired control for those joints.

In this system, spinal braces are described as sacroiliac (510), lumbosacral (LSO), thoracolumbosacral (TLSO), cervicothoraco lumbosacral (CTLSO), cervical (CO) and cervicothoracic (CTO) orthoses. Control is generally described in terms of spinal flexion, extension, rotation and or lateral (bending).

While this new nomenclature has helped, many traditional ways of naming and categorizing spinal systems remain in use. Orthoses may be classified:

  • as to rigidity (i.e. flexible vs. rigid);
  • by the presenting diagnosis (e.g. scoliosis brace); or
  • by details or materials used in fabrication (e.g. plastic body jacket).

The specific name of an ortho sis may be an eponym (e.g. Knight brace), credit the city or institution in which it was developed (e.g. Charleston bending brace), or reflect some other pertinent detail of its construction or application. But because the same orthosis is often known by different names in different disciplines, special-ties and geographic regions, the more complete the description when discussing or prescribing spinal braces, the less opportunity for confusion or error.

In particular, when prescribing a spinal orthosis, we recommend including: the diagnosis, generic nomenclature, eponym or common name, and additional specifications (e.g. plastic body jacket TLSO for spinal stability, bivalved with soft interface); expected duration of wear; and whether the device is to be worn during sleep or in the shower.

'...I'm Useful Again!' Down to Cases
Ann, 30, an otherwise-healthy, active wife and mother of four, suddenly found her life turned upside-down by events following the discovery of a large desmoid tumor in her left leg. A long and painful regimen of daily radiation and chemotherapy treatments left her weak, fatigued and unable to care for herself and her family and yet yielded no progress. At length, weary of a life diminished by therapy side-effects and a "useless" leg, she elected to proceed with amputation surgery.

When she came a week later to initiate prosthetic management, Ann's high-level transfemoral amputation presented the dual challenge of a difficult socket fit and very short lever-arm with which to control a knee component. Yet, this highly motivated patient fully intended to return to her full, active lifestyle, including chasing after kids and her favorite pastime, bicycling.

Accomplishment of that goal virtually demanded the ability to vary walking speed easily and efficiently without the resulting gait abnormalities experienced by most above-knee amputees. For that reason, her rehab team designed an advanced limb prosthesis built around a microprocessor-control system. Despite the complexity of this sophisticated new prosthesis, Ann was soon on a treadmill, smoothly walking through a range of speeds while her prosthetist fed programming inputs into her new system. From her first steps, it was obvious this component selection was a good one.

Designing and fabricating Ann's socket proved to be the greater issue. Her short, finn, very round residual limb caused lateral stability and internal rotation difficulties with the initial socket attempts. In such cases, patience and perseverance are essential to a successful outcome.

Fortunately, both this patient and her rehab team had plenty of both. After several rejections, the socket] suspension challenge was successfully addressed by a narrow M-L ischial containment design with a silicone sleeve and distal locking pin.
Today, Ann is back to living the life she thought she'd lost, totally convinced she made the right decision in choosing surgery. She has resumed her household and "mom" roles and participating in cross-country bicycle rides.

"For me, amputation was a good thing," she says. "I'm living again...I'm useful again!"

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