Spinal Orthosis

TEXTBOOK READING
SPINAL ORTHOSIS
Presented by :
Fitria Arianty C11112015 Aswin Yusuf C11112036
Intan Sari Umar C1112020 Ika Ardyanti C11112038
Fuji Febrianti C11112034 Dian Erawati P. C11112045
RESIDENT: SUPERVISOR :
dr. Handoko Dr.dr.Karya Triko Biakto, Sp.OT(K)Spine
dr. Roichan M. Firdaus
dr. Yoshua
ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENT

MEDICAL FACULTY OF HASANUDDIN UNIVERSITY
MAKASSAR
2018
Anatomi
 The vertebral column is composed of 7
cervical, 12 thoracic, 5 lumbar, 5 sacral, and
4 coccygeal vertebrae.
 The spinal cord is protected within the
vertebral foramen, and initially occupies the
entire length of the vertebral canal.
 By adulthood, the spinal cord occupies only
the upper two thirds of the vertebral column
with its caudal end located at the lower
border of the first lumbar (L1) vertebra (level
of L1-2 intervertebral disc)
Reference :
• Frontera WR, Delisa JA. 2010. Delisa’s Physical Medicine & Rehabilitation Principle and Practice. 5ed. Wolters Kluwer : China
 The stability comes from the fact that the spinal
column is actually three columns in one.
 The anterior column is composed of the anterior
longitudinal ligament and the anterior portion of the
vertebral body.
 The middle column is made up of the posterior wall
of the vertebral body and the posterior longitudinal
ligament.
 The posterior column is formed by the posterior
bony arch, which consists of the transverse
processes, facets, laminae, and spinous
processes.
 Each vertebra has the potential for six degrees of
freedom : translation in all three axes of movement
and rotation around each axis.
Reference :
 The cervical vertebrae have the greatest freedom
including free flexion, extension, lateral rotation, and
lateral flexion : larger disks, concave lower and
convex upper vertebral body surfaces, and
transversely aligned facet joints.
 Thoracic vertebrae have restricted flexion and
extension and limited rotation but freer lateral flexion
:attachments to the rib cage, smaller disks, flatter
vertebral body surfaces, frontally aligned facet joints,
and overlapped spinous processes.
 The lumbar spine has good flexion and extension
and free lateral flexion :large disks, posteriorly
directed spinous processes, and sagittally directed
facet joints.
Reference :
Definition
 An Orthosis is a device, applied to the exterior of the body, for the purpose of
supporting, correcting, aligning, or improving the function of moveable parts of the
body or reducing pain of the head, spine, or extremities.
 General terminology for orthoses may be organized into the following:
(1) lower limb,
(2) upper limb,
(3) spinal categories.
Reference :
• Fernández MG, Friedman JD. 2011. Physical Medicine and Rehabilitation Pocket Companion. Demons medical : United state of America
Definition
 Further subcategories are based on the joints affected by the orthosis.
Standardized terminology includes the use of simple initialisms describing the
joints affected and ending with “orthosis.”
 For example, ankle foot orthosis (AFO), wrist hand orthosis (WHO), and thoracic
lumbar sacral orthosis (TLSO) are standardized terms that allow for quick
communication of the basic device.
 Further descriptors may be added to specify the desired function, materials, or
design criteria. For example, articulated, dorsiflexion (DF) assist AFO; or wrist
powered tenodesis WHO; or rigid, tri-planar control, custom molded TLSO.
Reference :
• Fernández MG, Friedman JD. 2011. Physical Medicine and Rehabilitation Pocket Companion. Demons medical : United state of America
 A Spinal Orthosis is a device that provides support or restricts motion of the
spine.
 Spinal orthosis may also be prescribed to treat spinal deformities such as scoliosis.
All orthoses are force systems that act on body segments.
Reference :
• Devlin VJ. 2012. Spine Secret Plus. 2ed. Elsevier: United State of America
Mechanism
 Several orthoses offer various amounts of correction, but the basic principles of
stabilization are the same: endpoint control, transverse load, curve correction,
and a combined effect.
 The simple laws of Newtonian physics, which requires three points of fixation to
achieve joint stability, are no different in the spine.
 However, the very nature and complexity of the trunk make the biomechanics
behind spinal orthotic design much more complex since the spine is a series of
semirigid linkages, which are connected by tissues that function like springs.
 Each link has six degrees of freedom, making control of movement from an
external source quite difficult.
Reference :
 Orthoses are able to apply balanced perpendicular forces to create a (un)bending
moment in the curve, focused at the curve vertex.
 Force must be applied on the concave side above and below the level of the vertex
of the curve and it is countered by a force applied on the convex side at the vertex
of the curve
 They also improve endpoint control, which reduces sway in the neck and/or pelvis
and helps bear some of the spine’s transverse load. These effects may also be
helpful in controlling spinal deformity
Reference :
General Indication
 Some common indications for prescribing a spinal orthosis is to :
1. Prevent or correct a spinal deformity (e.G. Scoliosis, kyphosis),
2. To immobilize a painful or unstable spinal segment (e.G. Spinal fracture),
3. To protect spinal instrumentation from potentially dangerous externally applied

mechanical loads
Reference :
General Indication
 Orthoses have been used as nonoperative alternatives to spinal fusion in some
cases of microinstability and macroinstability and as postoperative adjuncts to
protect the surgical constructs used for stabilizing macroinstability in the
thoracolumbar spine.
 The postoperative orthosis should limit the gross motion of the trunk during
activities of normal daily living, thereby protecting the surgical construct from large
loads created from torso motion until solid biologic fusion occurs
Reference :
• Hsu JD, Michael JW, Fisk JR. 2008. AAOS Atlas of Orthoses and Assistive Devices. 4ed. Mosby : Philadelphia
Classification
 The most universally accepted classification system describes spinal orthoses
according to the region of the spine immobilized by the orthosis:
1. Cervical Orthosis (CO): e.g. Philadelphia collar
2. Cervicothoracic Orthosis (CTO): e.g. SOMI brace
3. Thoracolumbosacral Orthosis (TLSO) e.g. Jewett brace
4. Lumbosacral Orthosis (LSO): e.g. Chairback brace
5. Sacroiliac Orthosis (SIO): e.g. Sacroiliac belt
Reference :
CERVICAL ORTHOSIS
Cervical devices encircle the cervical spine, whereas cervicothoracic braces extend into the
thoracic spine.
References :
 Collars can help with conditions like torticollis, cervical
dystonia or certain genetic and developmental disorders or
brain injury like cerebral palsy, muscular dystrophy and
trauma.
 This can often cause by unbalanced control, spasms or
forceful contractions.
 So collars and braces are specially designed for support,
comfort as well as a rehabilitative approach using
neuromuscular restoration.
immobilizes your spine during healing
stabilizes injured areas
controls pain by restricting movement
References :
• Solomon, Louis, et al. 2010. Apley’s System of Orthopaedics and Fractures 9th Ed. Bristol:UK
 Prefabricated cervical orthoses can be generally
categorized as soft, semirigid, and hard
 The soft cervical orthosis, also known as a foam

collar, functions primarily as a kinesthetic
reminder for the individual to reduce excessive
motion
• Reference:
Hsu JD, Michael JW, Fisk JR. 2008. AAOS Atlas of Orthoses and Assistive Devices. 4ed. Mosby : Philadelphia
 Semirigid and hard cervical collar styles are
available in a great variety of prefabricated
styles.
 These orthoses reduce cervical motion in

the sagittal plane more than foam collars do
but still provide little control of lateral flexion
and rotation.
 Additional control of the cervical spine can

be provided by poster-style orthoses.
• Reference:
 Two-poster and four-poster designs of
cervical orthoses offer more rigid
immobilization of the cervical spine
because of the occipital pad, mandibular
pad, and sternal and thoracic pads.
 Many of the aforementioned orthoses can

be modified with a thoracic extension to
provide more effective stabilization for
motion control of the lower cervical spine.
• Reference:
Cervical Biomechanics
 The cervical spine is a highly mobile
structure allowing flexion,extension, lateral
flexion, and rotation; thus, motion occurs in
three planes: sagittal, frontal, and
transverse.
Reference :
• Frontera WR, Delisa JA. 2010. Delisa’s Physical Medicine & Rehabilitation Principle and
Practice. 5ed. Wolters Kluwer : China
• The atlantooccipital joint primarily permits flexion and extension, with minimal axial
rotation and lateral flexion.
• Functionally, this synovial joint enables an individual to nod their head. At the
atlantoaxial (C1-2) joint, the predominant motion is rotation. 50% rotation achieved by
the cervical vertebral column occurs at C1-2.
• Between C4 and C7, maximum flexion and extension. occurs, with the greatest motion
occurring at C5-6.
Reference :
• Lateral flexion (lateral side bending), however, occurs between C2 and C7 in the coronal
plane.
• The C2-4 region has the most side bending and rotation
• During flexion the vertebral foramina open and with extension close.
Reference :
• References :
Frontera WR, Delisa JA. 2010. Delisa’s Physical Medicine & Rehabilitation Principle and Practice. 5ed. Wolters Kluwer : China
www.uncpo.com/cervical collar use and care instruction
• References :
Frontera WR, Delisa JA. 2010. Delisa’s Physical Medicine & Rehabilitation Principle and Practice. 5ed. Wolters Kluwer : China
www.uncpo.com/cervical collar use and care instruction
Complication Of Cervical Orthosis
 Skin damage.
 At risk for pressure ulcers
 Spesifics areas of concern are the occiput, chin and mandible, ears, shoulders,
laryngeal prominence, sternum and macerated neck skin
 Swallowing, coughing, breathing, and vomitting limitations, potentially causing
aspiration.
 Additional injuries to the spinal cord occuring during hospitalization that may be
caused by ineffective cervical immobilization.
 Marginal mandibular nerve palsy (cranial nerve VII) with long-term sensory
compromise.
CERVICOTHORACIC ORTHOSES (CTOS)
 Cervicothoracic orthoses (CTOs) are used to extend the region of
immobilization to the lower cervical and upper thoracic levels and are
indicated for pathologies in the C1–T2 region.
Cervicothoracic Orthoses (CTOs)
 CTOs control flexion more effectively than extension due to the
longer mechanical anterior lever arms.
 They are commonly prescribed for stable fractures
 Flexion injuries in the C3–T1 region
 Extension injuries in the C3–C5 region, general postoperative
stabilization
Cervicothoracic orthoses (CTOs)
 The Sternal Occipital Mandibular Immobilizer (SOMI)
Biomechanic
 This orthosis consists of a sternal plate with shoulder components,
mandibular pad and bar, and occipital pad and bars.
 The Sternal Occipital Mandibular Immobilizer (SOMI) is an example

of a CTO and is an alternative to the poster style CO.
It is preferred when donning in supine is required as there are
no posterior bars.
The SOMI specifically limits flexion and is most effective in

the C1–C5 region.
it actually allows some extension motion because of a swivel-

type occipital pad
The Halo Cervicothoracic Orthosis
 The halo is a rigid CTO used for unstable cervical injuries and
particularly for upper cervical spine instability (occiput-C2).
• The halo ring is fixed into the skull with 4
screws and into 2 or 4 bars which then
attach to a rigid vest for shoulder and
upper thorax loading.
Biomechanic
 The halo cervicothoracic orthosis provides triplanar motion control in
the cervical spine
 This orthosis provides the best endpoint control of the cervical spine
 Its lack of total contact allows the occurrence of a phenomenon

called intersegmental snaking.
THORACOLUMBOSACRAL ORTHOSIS
SEMI RIGID/CORSET
 axillary strap attached to a posterior
thoracic section
 increases intra-abdominal
pressure and provides minimal
restriction against trunk flexion and
hyperextension
 to help control pain in generalized
osteoporosis, metastatic
malignancy, myeloma, and
thoracic osteoarthritis.(300)
 musculature can atrophy and
increase the chance of reinjury
RIGID ORTHOSIS
1. TLSO: Flexion control

(hyperextension orthosis)
 Aluminium frame with pads
 Jewett syle
 A single three-point pressure
system
 Restricts flexion of the spine
 Indication : compression fracture
Reference :
2. TLSO: Sagittal control
 Taylor style
 2 three-point pressure
system
 Consist : pelvic band,
axillary straps, paraspinal
bar, interscapular band
 Limits flexion and
extension
Reference :
3. TLSO: Sagittal-coronal control
 Knight-Taylor style
 Consist of thoracic band,
pelvic band, paraspinal bars,
lateral bars, interscapular
band, and axillary straps.
 Limits flexion, extension, and
lateral flexion of the thoracic
and lumbar spine
 Indication : postsurgical
support of traumatic
fractures, stable osteoporotic
fractures, spondylolisthesis,
scoliosis, spinal stenosis, and
herniated disks.
References :
• Weiss, Lyn D., 2010, Oxford American Handbook of Physical Medicine and Rehabilitation, New York : Oxford University Press
4. TLSO: Triplanar control
 Variation of Knight-Taylor style
 Consists of a thoracic band with
subclavicular extensions, pelvic
band, paraspinal bars, and
lateral bars
 Right or left rotation with
controled by thoracic band and
subclavicular extension limit
motion.
Reference :
5. TLSO: Triplanar control, soft
body jacket
 Effective triplanar
stabilization
 a rigid frame surrounded by
soft closed-cell foam
 limits flexion, extension,
lateral bending, and rotation
 Helpful for elderly
 Indication : treatment or
post surgical management
of traumatic or pathological
spinal fractures.
References :
LOW-PROFILE ORTHOSES
1. Boston
- one-piece, posterior-opening
- polypropylene
- prescribed for younger patients
with smaller, more flexible
curves
- treating either single- or double
curve patterns in which the apex
of the most cephalad curve is
located at T7 or below
Reference :
2. Rosenberger
- custom-molded
- low-density
- polyethylene
- anterior-opening
- similar to the Boston
and Wilmington
Reference :
3. Wilmington jacket
- one-piece, anterior
opening
- same as those for the
Boston brace.
- not effective in curves
with an apex above T7–
8
Reference :
4. Charleston Bending Brace
- limited number of hours of
daily use (8-10 hr)
- for single lumbar or
thoracolumbar curves with
magnitudes of 35 degrees or
less
Reference :
BIOMECHANIC
 Restriction of trunk motion in flexion–extension, lateral bending, and axial
rotation
 intermediate degree of gross motion restriction, and the elastic corset is
only minimally restrictive
 reduces intervertebral motion in the lumbar spine
 reducing motion at the upper lumbar levels than at lower levels
Reference :
LUMBOSACRAL ORTHOSIS (LSO)
 Lumbosacral orthoses (LSOs) are recommended to manage pathologies in the L2–
S1 region.
 The LSO may be either flexible (Semirigid) or rigid
References :
• Fernandez Marlis Gonzalez, 2011, Physical Medicine and Rehabilitation Pocket Companion, New York : Demos Medical
• DeLisa, Joel A, 2010, DeLisa’s Physical medicine and Rehabilitation, 5th Ed, Philadelphia : Lippincott Williams & Wilkins
1. LSO Semirigid/Flexible
a. Corset
 A corset style LSO is a commonly prescribed semirigid
spinal orthosis for the relief of low back pain.
 These are garments made of typically
prefabricated fabric, which are closed in the
front with Velcro or laces and encircle the
lumbar and abdominal areas.
 Designs vary and include the
lumbar/abdominal binder, the Warm-N-Form,
and the lumbosacral corset.
References :
• Fernandez Marlis Gonzalez, 2011, Physical Medicine and Rehabilitation Pocket Companion, New York : Demos Medical
 The lumbosacral corset is longer than the binder, with the anterior-
superior border extending to just below the xiphoid process and the
inferior border to just above the pubic symphysis.
 In addition to its use for pain relief, it provides postural, vasomotor, and
respiratory support in cases of paralysis.
 In patients with paralysis and respiratory insufficiency, it places the

diaphragm in a superior position and can assist the patient with increased
diaphragmatic expansion.
Reference :
b. Binder
 The binder is elastic and must be wrapped tightly around

the lumbar and lower abdominal area in order to elevate
intraabdominal pressure.
 A common error in donning the binder is placing it above

the diaphragm. The addition of a thermoplastic insert
(Warm-N-Form) molded to the patients’ lumbar curve and
inserted into a posterior pocket may provide increased
support and feedback.
Reference :
c. Belt
 The LS belt is more comfortable since it does not extend up and down as much as
the corset.
 This orthosis increases intra-abdominal pressure and it is postulated to decrease

spinal load.
 Nevertheless, they sometimes provide warmth and psychological comfort in patients

with low back pain associated with many disorders such as herniated disks, lumbar
muscle strain, or osteoarthritis.
 This type of brace is also sometimes used for immobilization after lumbar
laminectomy.
Reference :
LSO Rigid
The rigid LSOs are categorized in the same fashion as the
TLSOs, namely by the motion they control; in this case
flexion-extension, flexion-extension-lateral, and extension-
lateral.
Reference :
a. Flexi-Extension (Sagittal) Control Orthosis
 This orthosis (also known as LSO: chairback style) consists of a
thoracic band, pelvic band, and two paraspinal bars.
 This device is indicated for reduction of gross motion in the sagittal
plane, including both flexion and extension. The mechanism
consists of 2 three-point pressure systems.
 Flexion control is achieved via two posteriorly directed forces (at
the xiphoid level and the pubic level on the corset panel) and one
anteriorly directed force at the midpoint of the paraspinal bars.
 Extension control is achieved via two anteriorly directed forces
(arising from the thoracic and pelvic bands) and one posteriorly
directed force from the midpoint of the corset panel.
 This orthosis uses preformed anterior and posterior acrylonitrile-
butadiene-styrene (ABS) plastic panels lined with soft breathable
foam.
Reference :
• Hsu, John D. et al, 2008, AAOS Atlas of Orthoses and Assistive Devices, 4th Ed, Philadelphia : Elsevier
b. Flexi-Extension-Lateral (Sagittal-Coronal) Control
Orthosis
 Also known as the Knight brace it further limits motion with
lateral uprights added to the chairback brace
 The current form of this orthosis consists of a thoracic band,
pelvic band, paraspinal bars, and lateral bars.
 The thoracic band is positioned just below the scapulae and
extends laterally to the mid-axillary line.
 The pelvic band lies just over the apex of the buttock and
extends laterally to the mid-trochanteric line.
References :
 In addition to the three-point pressure systems described for restriction of sagittal
plane motion, this orthosis adds three-point pressure systems in the coronal plane
to limit lateral flexion.
 This anterior-opening design integrates rigid sides that provide motion restriction
in the coronal plane. The frame can be recontoured by heating and reshaping as
necessary.
 The soft inner liner is made of breathable foam for increased patient comfort.
 It is usually indicated for spondylolisthesis, postoperative lumbar laminectomies,

fusions, or diskectomies.
References :
c. Extension-Lateral (Extension-Coronal) Control Orthosis
 The Williams orthosis limits extension and lateral motion but encourages flexion
 It prevents hyperlordotic posture
 It consists of pelvic and thoracic bands joined by a pair of lateral uprights (no
posterior uprights), which decreases the lateral motion.
 The thoracic and lateral bars are directly attached to each other but the pelvic band
is attached to the lateral upright with oblique lateral bars that pivot at the top but
secure rigidly at the bottom.
 The abdominal support is elastic and an adjustment strap between the pairs of
uprights acts as a lever to pull the oblique uprights more posterior and decrease the
lordosis.
References :
 As the device is worn, an inelastic pelvic strap is tightened so
that free flexion can occur, but extension is stopped.
 Thus is generally used for spondylolysis and

spondylolisthesis.
 Contraindications for use are spinal compression fractures.
References :
Thoracic and Lumbosacral Spine Biomechanics
 The thoracic spine can be thought of best by dividing into upper (T1-4), middle (T5-
8), and lower (T9-11) segments and the lumbar spine as the thoracolumbar
junction (T12-L1), mid-lumbar (L2-4) segment, and the lumbosacral junction (L5-
S1).
 The 12 thoracic vertebrae are limited in motion in all directions by their attachment
to the ribs and orientation of the facet joints; they are further limited in extension by
overlapping of their spinous processes.
 As one moves in a craniocaudal direction, the range of sagittal plane flexion-

extension motion increases.
References :
 The coronal plane (lateral) flexion-extension motion and axial
rotation increases to the maximum degree at the lower thoracic and
thoracolumbar junction, and then decreases again.
 At the thoracolumbar junction, the curvatures of kyphosis and
lordosis change direction, the facet joints change direction from
frontal to sagittal plane, the gravity line bisects the T12-L1 disc and
there is the weakest muscular protection.
 As a result, this area is considered the most mobile segment and is
prone to traumatic injuries.
 The lower lumbar segments, L4-5 and L5-S1, are more susceptible
to herniated discs and spondylolisthesis
References :
Complication of LSO
1. Local pain,
2. Skin breakdown,
3. Gastrointestinal disorders,
4. Decreased vital capacity,
5. Increased lower extremity venous pressure,
6. Higher blood pressure, and
7. Higher heart rates
Reference :
Sacroiliac Orthosis
 Sacroiliac corsets are meant to provide
assitance to the pelvis only.
 These garments encompass the pelvis with

endpoints inferior to the waist and superior to
the pubis.
Reference :
Hsu, John D, et al. AAOS Atlas of Orthoses Assistive Devices. Ed 4. 2008
• Sacroiliac orthoses include trochanteric belts,
sacral belts, and sacral corsets.
• They are prefabricated devices that wrap around
the pelvis between the iliac crests and greater
trochanters.
• They are differentiated by the height of their
superior borders, their adjustability, and
materials.
• They may have perineal straps attached to
prevent upward displacement and a sacral pad to
apply pressure over the sacrum .
Reference :
Delisa, Joel A. Delisa’s Physical Medicine & Rehabilitation. Ed 5. 2010
 While minimally effective in restricting motion, they may
increase the intra-abdominal pressure and provide
kinesthetic feedback to maintain a neutral pelvis.
 These devices can help to stabilize the sacroiliac joint,

support pelvic fractures and traumatic sacroiliac joint
separations, decrease sacroiliac joint pain and pregnancy–
related and postpartum pain
Reference :
Delisa, Joel A. Delisa’s Physical Medicine & Rehabilitation. Ed 5. 2010
 Design: Belts that wrap around the pelvis between
the trochanters and the iliac crests
 Indications: During pregnancy when laxity of the

sacroiliac or anterior pelvic joints may cause pain
or for other conditions affecting the sacroiliac
joints
Reference :
Devlin, Vincent J, MD. Spine Secrets Plus. Ed 2. 2012
Rehabilitation
Admission to inpatient orthopedic rehabilitation depends on
the patient’s degree of disability, their medical complexity,
and social factors that would affect their functional
independence in post hospital discharge such as
availability of support and the accessibility of their home.
Reference :
Fernández MG, Friedman JD. 2011. Physical Medicine and Rehabilitation Pocket Companion. Demons medical : United state of America
Rehabilitation
 Goals of therapy focus on improving mobility, balance, strength, range of motion,
gait, and activities of daily living (ADLs).
 Therapy goals should carryover to the outpatient setting.
 Due to the risk of developing complications in the acute postoperative period,

physician monitoring and medical management in an inpatient setting are often a
necessary first step to facilitate the patient’s successful functional recovery.
Reference :
Rehabilitation
 Admission to inpatient orthopedic rehabilitation depends on the patient’s
degree of disability, their medical complexity, and social factors that would
affect their functional independence in post hospital discharge such as
availability of support and the accessibility of their home.
Reference :
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TEXTBOOK READING

ORTHOPEDIC AND TRAUMATOLOGY DEPARTMENT

 General terminology for orthoses may be organized into the following:

(1) lower limb,

(2) upper limb,

(3) spinal categories.

2. To immobilize a painful or unstable spinal segment (e.G. Spinal fracture),

3. To protect spinal instrumentation from potentially dangerous externally applied

2. Cervicothoracic Orthosis (CTO): e.g. SOMI brace

3. Thoracolumbosacral Orthosis (TLSO) e.g. Jewett brace

4. Lumbosacral Orthosis (LSO): e.g. Chairback brace

5. Sacroiliac Orthosis (SIO): e.g. Sacroiliac belt

 The soft cervical orthosis, also known as a foam

 These orthoses reduce cervical motion in

 Additional control of the cervical spine can

 Many of the aforementioned orthoses can

 The Sternal Occipital Mandibular Immobilizer (SOMI) is an example

The SOMI specifically limits flexion and is most effective in

it actually allows some extension motion because of a swivel-

 Its lack of total contact allows the occurrence of a phenomenon

1. TLSO: Flexion control

 The LSO may be either flexible (Semirigid) or rigid

 In patients with paralysis and respiratory insufficiency, it places the

 The binder is elastic and must be wrapped tightly around

 A common error in donning the binder is placing it above

 This orthosis increases intra-abdominal pressure and it is postulated to decrease

 Nevertheless, they sometimes provide warmth and psychological comfort in patients

 It is usually indicated for spondylolisthesis, postoperative lumbar laminectomies,

 Thus is generally used for spondylolysis and

 Contraindications for use are spinal compression fractures.

 As one moves in a craniocaudal direction, the range of sagittal plane flexion-

 These garments encompass the pelvis with

 These devices can help to stabilize the sacroiliac joint,

 Indications: During pregnancy when laxity of the

 Therapy goals should carryover to the outpatient setting.

 Due to the risk of developing complications in the acute postoperative period,

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