An orthotic device is an apparatus that is applied externally to the body to do one or more of the following things for a part of the body:
- Limit the range of motion
- Correct deformity
- Improve the function
- Reduce the load on the affected area
There are several different types of spinal orthotic device, each designed for a particular area. Your doctor will determine which orthotic is the best for you, based on the nature and extent of your injury and the length of your recovery time.
A cervical orthosis is most commonly the soft collar neck brace. Typically made of polyurethane foam rubber and covered with fabric, it offers some protection to the neck.
- Head support for acute neck pain
- Relief from cervical strain
- Psychological comfort
- Limited restriction of motion
- Soft-tissue around neck limits application of force
Hard cervical collars have a similar shape to the soft collar neck brace but are made of a rigid polyethylene material with padding. They are more durable than the soft collar and provide more restriction of motion than the soft collar.
Head Cervical Orthoses
These orthotic devices have a collar as well as anterior (front) and posterior (rear) struts that offer support. These orthoses provide far stronger motion restriction than either the soft or hard collars.
The Philadelphia collar is a two-piece device that is made of a mix of rigid polyethylene and foam. It has a hole allowing for access for tracheostomy (surgically-created breathing hole in the neck).
Miami J Collar
This is a somewhat smaller head cervical orthotic device, made of a two-piece polyethylene system with a washable lining, which still provides ample motion restriction while being easy to don or remove. It has an anterior opening to allow for tracheostomy.
Yet another head cervical orthotic device, the Malibu collar is a two-piece, semi-rigid system with an anterior opening for tracheostomy. While providing somewhat less restriction of motion than either the Philadelphia or Miami J collars, it is adjustable to offer a proper fit for the patient.
This two-piece, semi-rigid orthotic system is made of polyethylene, has an anterior opening for tracheostomy, and is easily donned or removed by means of Velcro. Its motion restriction is similar to that of the Malibu collar.
Made from high-density polyethylene and lined with soft polyethylene foam, it offers comparable stability and motion restriction as the Miami J and Philadelphia collars.
The cervicothoracic orthotics (CTOs) offer still greater motion restriction for the middle-to-lower cervical spine, with less motion restriction to the upper cervical spine.
Sternal-Occipital-Mandibular Immobilizer (SOMI)
This three-post CTO is rigid, with an anterior chest plate as well as metal bars that go over the shoulder and connect with the anterior plate. The chin plate attaches to the chest plate, and may be removed when the patient eats.
Once adjusted properly, the SOMI is relative comfortable for patients to wear, and is ideally suited for bedridden patients because of the absence of posterior rods, and offers high levels of motion restriction.
This orthotic is actually a modification to the Philadelphia collar, with fiberglass extensions that link up with both anterior and posterior midthoracic straps. It offers a great deal of motion restriction.
This rigid orthotic device has anterior and posterior chest pads connected by straps at the chest and shoulder, offering superior bracing to the Philadelphia collar and superior motion restriction.
This CTO is a rigid, two-poster system, with anterior and posterior chest plates that are connected by shoulder straps, with a chin plate.
The Halo device is most commonly used for cervical and upper thoracic fractures, providing unsurpassed restriction of motion relative to other orthotics. The halo ring, made of graphite or metal, has pin fixation hardware at different points along the skull, and has four-post attachments offering anterior and posterior support. Made of rigid polyethylene, it must be properly fitted to the patient for optimal effectiveness.
Some complications of the halo device include:
- Neck pain or stiffness
- Loosening of the pins
- Infection at site of pins
- Pain at pin sites
Thoracolumbar Orthoses (TLOs)
Thoracolumbar orthoses, or TLOs, are used primarily for fractures between T10 and L2 on the spine, where immobilization will avoid further damage.
The cruciform anterior spinal hyperextension (CASH) brace is easy to wear, but must be carefully adjusted. It connects the thoracolumbar region of the body by means of pads connected by a cross-shaped bar. This reduces pressure on the chest and pelvic regions.
Jewett Hyperextension Brace
The Jewett hyperextension brace combines two anterior and one posterior pads to form a three-point pressure system over the sternum and pelvic region. This provides restriction of motion between T6 and L1 regions of the spine. This brace offers more effective immobilization than the CASH brace.
This orthotic system has a corset-type front with both lateral and posterior supports and shoulder straps. Cross supports within the orthotic provide lateral motion restriction.
The thoracolumbosacral orthosis (TLSO) is made of polypropylene or plastic, and is a custom-molded “clamshell” body jacket designed to be lightweight, easy to put on or remove, comfortable, and easy to clean. It limits motion and rotation, and must be periodically checked to ensure that the fit is correct, for the maximum comfort of the patient.
Lumbrosacral Orthoses (LSOs)
This orthotic is a rigid, short system with two posterior upright supports with pelvic and thoracic bands. There are adjustable straps along the abdominal apron that allow for the increase of pressure. This brace has a three-point pressure system capable of being custom-molded for best fit, and provides restriction of motion and lateral bends, offering relief of lower back pain and immobilization of the region after lumbar laminectomy.
Chairback Ortho-Mold Brace
Structurally similar to the chairback brace, this orthotic has a rigid back piece made of plastic that is custom-molded to the patient. It offers immobilization similar to the chairback brace.
This LSO offers bracing and motion restriction while allowing forward flexing. This brace is often used for treatment of:
This orthotic lacks lateral uprights, limiting motion only on flexion and extension, and is used much the way the chairback brace is used.
Standard Lumbosacral Orthotic Corset
Adjustable, with cloth-covered metal bars that can be moved as required, this corset can be used for lower back pain and for immobilization after lumbar laminectomy.
This rigid orthotic is custom-made for the patient for best fit, with overlapping anterior and posterior shells ensuring a tight fit, and has the added benefit of being designed to be able to be used in the shower, if necessary. It is often used for treatment of lumbar compression fractures and for lumbar immobilization after surgery, and limits flexion and extension as well as some rotation and lateral bending.
Rigid LSO with Hip Spica
This LSO has an additional thigh piece that is set at an angle to allow sitting and walking, while providing motion restriction to help deal with lumbar instability and any postoperative lumbosacral fusion anchored to the sacrum.
Orthotics for Scoliosis
Orthotics for scoliosis are intended to prevent further deformity of the spine and to prevent or delay surgery—delaying surgery helps avoid stunting the patient’s growth. Your doctor will determine whether a brace is indicated by the degree of the curvature and the age of the patient. Some of the orthotics include:
This orthotic is designed to stimulate the patient’s body to correct the deformity through active engagement of muscles of the trunk. There is a thoracic pad placed that encourages a righting response in the patient, and there is a neck ring to provide additional traction (although it carries some risk of jaw deformity). The bracing is adjustable for age, change in height and spinal growth, but will have to be changed as the pelvic region grows. It is ideal for curves of 30 to 40 degrees.
Some complications of the Milwaukee brace include:
- Jaw deformity
- Mobility and transfer difficulties
- Unsightly appearance
- Skin breakdown
This orthotic may be worn under clothes, is prefabricated and cannot be adjusted as the patient grows in height. It works best with patients of curvatures of 20 to 30 degrees, and must be precisely fitted to the patient.
Some problems associated with the Boston brace include:
- Trunk weakness
- Discomfort locally
- Pressure on the abdomen
- Skin breakdown
Physical therapy such as stretching (particularly at the hip) and exercise can help offset some of the complications of the Boston brace.
Charleston Bending Brace
This orthotic is a custom-made, rigid system designed to offer corrective pressure at nighttime. It is best suited for a curvature of 20 to 30 degrees, although it has been found to be somewhat less effective than the Boston brace.