Trauma Management

Spinal Orthotics
Classified according to vertebral level and
mechanism of injury

Pathology of the Spine

Trauma Management Cervical Spine Trauma Management Cervical Spine

Flexion Injuries Flexion Injuries

Wedge Compression Bilateral Facet Dislocation
Stable - CO Very unstable - immobilization

Flexion Teardrop
Unstable - immobilization

Clay Shoveler Fracture

Stable - immobilization
Anterior Subluxation
Stable - depends on severity

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Trauma Management Cervical Spine Trauma Management Cervical Spine

Flexion-Rotation Injury Extension Injuries

Unilateral Facet Dislocation Hangman Fx (C2)
Stable depends on severity Unstable CO if no dislocation

Extension Teardrop Fx
Very unstable in extension
Surgery or immobilize

Posterior Neural Arch Fx (C1)

Stable - CO

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Trauma Management Cervical Spine Trauma Management Thoracic & Lumbar

Compression Injuries Flexion Injury

Jefferson Fx (burst C1) Wedge fracture
Very unstable Halo Orthosis Depends on severity
Hyperextension Orthosis

Burst Fx of Vertebral Body

Depends on severity
Compression Injury
Burst / Compression Fx
Depends on severity
Extension Orthosis

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Tauma Mnagement - Thoracic & Lumbar- Trauma Management - Thoracic & Lumbar
Flexion-Distraction Injury
Unstable fracture
Chance (Seatbelt) Fx
Flexion dislocation fracture Usually Stable
Flexion rotation dislocation Immobilize LSO/TLSO
fracture Rotation Injury
Posterior dislocation Fx / Dislocation
fracture Depends on severity
Immobilize

An unstable thoraco-lumbar spine is usually treated surgically primarily

followed by an orthosis such as a body jacket post-operatively. If the
cervical fracture is unstable a halo should be the initial treatment. Fusion
of only a single cervical level may be managed with a collar whereas when
more vertebrae are involved a halo may be indicated.
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Tuberculosis of the Spine - Potts Disease Spinal Cord Injury (SCI)

Most common form of TB of the bone Damage to the spinal cord

TB invades IVD bone & cartilage damage that results in loss of
function
Usually Thoracic & Lumbar
Usually from trauma like
Early treatment essential immobilize & reduce load
car accidents, motor bike
LSO / TLSO
accidents, falls, sports, etc.
Untreated vertebral collapse, kyphosis, paralysis
Can be complete or
incomplete
Knowing the level can help
you predict the functional
losses
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Spinal Cord Injury Spinal Cord Injury

C1 C4 T2 T8
May require ventilator Retain UE function
C5 Poor trunk control
Retain shoulder & bicep T9 T12
C6 Retain trunk control
Retain wrist control Good sitting balance

C7 T1 Lumbar & Sacral

Arm extension, limited Functional loss limited to
dexterity LE, bowl, & bladder

13 14 http://www.aqavic.org.au/sci_facts/whats_sci.html

Paraplegia Spina Bifida

Body Jacket or LSO may be attached to HKAFO to assist
with standing but will require very high energy
Malformation of spine in
expenditure to ambulate
unborn child
LSO / Corset may help with trunk control when sitting
in wheelchair, transferring, and some ADLs
Spinal Orthosis may be
prescribed to protect the
site or give trunk support

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Scoliosis Scoliosis

If you are referred a patient with How to identify Scoliosis

Unequal waist, shoulder, or scapulae
scoliosis, refer them on to a specialist
LLD toe & heel walking
in the field.
Rib hump Adams forward bending test
Lateral spine curvature
Scoliosis is only treated orthotically by those who are
trained in the treatment of spinal deformities.

Only specialists with an in-depth knowledge of

scoliosis treatment should make a spinal orthosis for
a scoliosis patient. Incorrect treatment can make
the curvature worse.
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Scoliosis Orthotic Management Scoliosis Orthotic Management

Guidelines Design TLSO / CTLSO

< 20follow-up Boston Brace
20 - 40orthotic Providence
management Charleston
>40surgery SpineCor
Goals Milwaukee
Prevent curve progression Treatment Plan
Minimize deformity Depends on orthotic
Prevent compressive stress design
Allow respiration

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Cervical Conditions Low Back Pain

Flexion, hyperextension and lateral sprains Mechanical Pain Orthotic Goals

Motion control via collar or post-orthosis to reduce pain and Muscle weakness Reduce pain
spasm Skeletal instability Allow healing
Short term use Degenerative Disc Disease Biomechanics
(DDD) Increase Intra-abdominal
Osteoarthritis (OA) pressure
Acute Injury Reduce movement
Realign Spine
Designs range from flexible
LSO/Corset to more rigid

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Patient education Spondylosis

Patient education is also IVD bulging leads to bone

very important! Please ask damage
your patient about their Can lead to
daily activities. Pain
Stiffness
Disc prolapse
Spinal stenosis
Spondylolisthesis
Especially cervical region

Osteophyte(Bone spur)
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Spondylolisthesis Spondylolisthesis Scottie Dog Fracture

Caused by bilateral fx of
pars interarticularis
Vertebra slips anteriorly
Can cause nerve damage
LSO / Corset
Increase intra-abdominal
pressure
Flatten lumbar lordosis
Correct pelvic tilt

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Ankylosing Spondylitis Rheumatoid Arthritis

Chronic Spinal Inflammation Orthotic aims are to reduce pain and prevent deformity
Unknown cause genetic?
Causes pain & stiffness Control motion & prevent deformity
Can lead to fusion
Loss of mobility Design depends on level
Orthosis can be used to LSO
prevent progression and TLSO
support adjacent areas CO

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 Thank you

any questions?