SPINAL ORTHOSES

TYPE EXAMPLES MOTION RESTRICTION INDICATIONS NOTES

Cervical Orthoses Soft collar FE Mild soft tissue injury;
Stable fractures;
Post-operative healing
Philadelphia FE Stable mid cervical injuries;
Aspen Following mid or low cervical spine surgery/instrumentation;
Miami J As an interim measure while awaiting surgery for head cervicothoracic orthoses
immobilization
Cervicothoracic Orthoses SOMI FER Stable cervical fractures;
Yale Atlanto-axial instability or C2 arch fractures
Four-poster
Head Cervicothoracic Halo* FELR Unstable injuries of the cervical or upper thoracic spine *Halo: effective in limiting C1-C2
Orthoses Minerva movement
Cuirass
Thoracolumbosacral CASH F Stable vertebral compression fractures of the lower thoracic and upper lumbar vertebrae
Orthoses Jewett
Lumbosacral Orthoses LS corset FEL* Mechanical back pain *Intermediate degree of motion
Lumbar strain restriction
Mild degenerative changes on lumbosacral spine
Post-op single column compression fxs with 1/3 or less anterior height loss
Knight FEL Inflammatory spinal arthritis limited to the upper lumbar region
Taylor FE Spinal tumors especially in pediatric patients* *TLS corset with rigid stays is often
sufficient for adult spinal tumors
Knight-Taylor FEL Inflammatory spinal arthritis and compression fractures of the lower thoracic and upper
lumbar region; spinal tumors
Cowhorn FLR Conditions leading to kyphosis (e.g. Juvenile Spinal Osteochondrosis)
Chairback FE Post-opeartive laminectomies and fusion
Williams EL Traumatic spondylolysis or spondylolisthesis
Sacral Orthoses Sacral corset Pelvic or pubic symphysis injury
Trochanteric belt
Orthoses for Correction of Milwaukee (CTLSO) Control or correct spinal curvature up to 40-45 degrees;
Scoliosis Better control for higher mid-thoracic curves
Boston (TLSO) Reduce and prevent progression of lumbar, thoracolumbar, thoracic curves with apices
below T8
Miami (TLSO) Reduce and prevent progression of lumbar, thoracolumbar, thoracic curves with apices
below T6
Wilmington (TLSO) Reduce and prevent progression of lumbar, thoracolumbar, thoracic curves with apices
below T8
New York Orthopedic Reduce and prevent progression of lumbar, thoracolumbar, low thoracic curves* *Additional accessories may be
Hospital Orthosis incorporated for control of higher
(NYOH) thoracic, cervical, and kyphotic curves
(Charleston, Providence Nighttime braces
 SPINAL INSTABILITY

Spinal fractures, whether caused by disease or trauma, can range from a mildly painful condition to a serious and even life-threatening situation. Since the human spine
is a complex structure, spine surgeons need to be very careful in diagnosing exactly where a fracture occurs. Accurate classification of a spinal fracture is a very important factor
in determining the appropriate treatment plan.

The Three-Column Concept

When describing and diagnosing spinal fractures, spine surgeons divide the spinal column into 3 sections:

1. Anterior column - made up of the anterior longitudinal ligament and the anterior one-half of the vertebral body, disc, and annulus.

2. Middle column - made up of the posterior one-half of the vertebral body, disc, and annulus, and the posterior longitudinal ligament.

3. Posterior column - made up of the facet joints, ligamentum flavum, the posterior elements and the interconnecting ligaments.

Types of Fractures
Most spinal fractures can be classified into 4 main types, including:

Wedge fractures - a compression fracture in which the front part of the vertebral body is crushed, forming a wedge shape.

Burst fractures - when the vertebral body is crushed in all directions, potentially causing bone fragments to enter the spinal canal.

Dislocation injuries - occurs when any part of the spinal column breaks away from another part, often caused by severe compression, rotation, or tension.

Seat belt fractures - often the result of a car crash when the passenger is wearing a lap-only seat belt and experiences a forceful forward flexion of the spine.

Stable and Unstable Fractures

Generally, a fracture is considered stable if only the anterior column is involved, as in the case of most wedge fractures. When the anterior and middle columns are involved, the
fracture may be considered more unstable. When all three columns are involved, the fracture is by definition considered unstable, because of the loss of the integrity of the
posterior stabilizing ligaments. The table below shows the types of fractures, the part or parts of the spine involved, and whether or not it is a stable or unstable injury.

Type of Fracture Column Affected Stable vs Unstable

Wedge fractures Anterior Only Stable
Burst fractures Anterior and middle Unstable
Fracture/dislocation injuries Anterior, middle, posterior Unstable
Seat belt fractures Anterior, middle, posterior Unstable