Trunk orthoses CAD manufactured and prefabricated

Correcting and influencing the sagittal profile of the spine.

 

scheuermann kyphosis tlso trunk orthoses brace in service fabrication by ortholutions

Fig. 1 Condition of the orthosis module after fitting. Markings specify last small modifications. All technical requirements (application zones and free spaces) that are set for the aid due to the indication (M. Scheuermann, thoracic type) are met.

Introduction

Influencing and / or correcting the sagittal profile of the vertebral column using orthoses seems to be easy. However, the orthoses must meet important criteria in order to be effective.

The biomechanical design, the selection of material and the directly associated strength properties are decisive for the function and the results.

Every orthopaedic technology team aims at fitting trunk orthoses using the least invasive procedures, while still providing maximum function.

This starts with the decision whether the work should be performed using a plaster cast, CAD technology systems or prefabricated orthoses. Trunk orthoses must have high functional properties in order to meet the requirements of a correcting orthosis or an orthosis that modifies statics.

Possibilities of adjustment to the course of therapy and to specific everyday life situations are obligatory. If reclination elements are fitted, they must ensure absolute dimensional stability. This article presents fitting systems that are manufactured without a plaster cast by using the individual body measurements and CAD technology or on the basis of prefabricated trunk orthoses. The biomechanical orthosis design (individual or prefabricated) in the examples shown below is based on the same proven principles of construction and function.

Preparation, procedure, fitting

Fig. 2 Completed orthosis module for the correction of Scheuermann’s disease, thoracic type. Clearly visible: The orthosis almost only consists of elements that constitute the correction zones.

Body measurements and photos of the four clinical views are required for the individual orthoses produced using CAD technology as well as for the prefabricated orthoses.

The orthoses are supplied ready for fitting and can be immediately used for the first fitting. The first step after the fitting of the blank orthosis is the control of the basic fit.

It is then checked whether the correction zones of the orthosis have a good fit and apply the required correction forces.

After that, the tailoring of the orthosis is determined.

It is important to define the exact height and area of the correction zones.

If they are not well adjusted, correction movements are strongly restricted or are not possible at all.

On the contrary, undesired compression effects are created. Pads must be fitted to protect the skin and to intensify the correction pressures.

All surplus materials that do not contribute to functionality can be removed. It is important that the rigidity of the frame structure must be adapted to the correction forces to be applied. In case of modules with reclination elements, the positioning and fixation of the reclination brackets that are shaped anatomically and can be adjusted thermoplastically follow.

Depending on the indication, it can be decided whether they are fitted to be adapted using a nylon closure or screwed tightly. The advantage of the adjustable variation is that the patients can adjust the correction pressure themselves.

Indication

scheuermann kyphosis thoracolumbar trunk orthoses tlso brace in service fabrication by ortholutions

Fig. 3 Orthosis for the treatment of Scheuermann’s disease, thoracolumbar type.

The range of indications of the orthosis modules covers the treatment of malformations, degenerative as well as traumatologic and neurological changes of the vertebral column.

In addition, the modules for influencing the lumbar spine in particular are used for pain therapy.

Examples of TLSO fitting

Example 1: Scheuermann’s disease, thoracic type

The correction principles of TLSO are: flexion / delordosing of the lumbar and extension / reclination of the thoracic vertebral column.

The pressure zones are:
the sacral bone (as caudal as possible),
medial of the anterior, superior spines.

And ventral application to the costal bones (level approx. nine and ten), thoracic apical vertebra, region of the head of the humerus.

Two three-point systems result according to the zones of application.The orthosis must ensure sufficient space of expansion to enable the chest to expand laterally, away from the correction zones, when breathing.

The expansion (bucket handle rib motion) of the chest laterally when breathing in is an essential part of the correction and must be ensured. The movement of the lumbar vertebral column in frontal plane is unrestricted (Fig. 1 and 2). 

Example 2:  Scheuermann’s disease, thoracolumbar type

Fig. 4 Patient after complicated thoracolumbar vertebral fracture. Thanks to the orthosis, the patient is able to exercise her profession again. The adjustable reclination brackets also enable the patient to drive a car. A strap on the ventral frame is sufficient to fix the trunk orthosis.

The correction principles of TLSO are: flexion / delordosing of the lumbar and extension / reclination of the thoracolumbar vertebral spine.

The pressure zones are: the sacral bone (as caudal as possible), medial of the anterior, superior spines, thoracolumbar apical vertebra and the region of the head of the humerus.

The correction zones constitute two overlapping three-point systems: a short three-point system for lumbar correction and a long one for thoracolumbar straightening.

The long leverages (application medial of the spines – thoracolumbar apical vertebra – region of the head of the humerus) allow for a very effective adjustment of the correction effect of the orthosis.
The lateral expansion of the chest (bucket handle rib motion) must be ensured. The lateral flexion of the lumbar vertebral column is unrestricted (Fig. 3 and 4).

Example 3: Spondylolisthesis / delordosing of the lumbar spine in general

tlso brace for - spondylolisthesis to straighten lumbar lordosis and sagittal profile fabrication

Fig. 5 Patient with marked spondylolisthesis. The design of the orthosis is limited exclusively to functionality. The straightening of the pelvis and the modification of statics with fitted orthosis is clearly visible

The correction principles of TLSO are: maximum flexion / delordosing of the lumbar vertebral spine.

The pressure zones are: the sacral bone (as caudal as possible), medial of the anterior, superior spines, thoracic and / or thoracolumbar application.

To be flexible, the modules are supplied with a ventral rib application. Therefore, it can be decided during the fitting how the corset module should be tailored.

The correction zones constitute a three-point system. The lateral flexion of the lumbar vertebral spine is unrestricted (Fig. 5 and 6).

 

Example 4: Scheuermann’s disease, lumbar type / lordosing of the lumbar spine in general

The correction principles of TLSO are: lordosing of the vertebral spine. The pressure zones are: central lumbar spine, pubic bone, ventral rib application. The correction zones constitute a three-point system.

tlso brace for spondylolisthesis to straighten lumbar lordosis and sagittal profile

Fig. 6 Inflecting orthosis for chronic pain symptoms of the lumbar spine. The biomechanical function of the orthosis can be verified well by looking at the sagittal profile

The lateral flexion of the lumbar spine is unrestricted. To ensure the versatility of the module, the blank orthosis (as standard variation) is supplied with closed pelvis.

Thus, first of all, the lateral flexion is fixed.

The tailoring options offered by the module allow for the adjustment of the function according to the requirements set by the indication (Fig. 7 and 8).

Results and practical experience

Excellent characteristics to be underlined for all systems presented are the primary accuracy in fitting and comfort while offering maximum function.

The complete course of fitting is very effective and uncomplicated. This is based on the versatility of the basic modules through individual tailoring variations. These characteristics are decisive for the high patient compliance and thus constitute the basis for the fact that indication-related wearing times are achieved without unnecessary loss of time for adjustment work due to problems of fit.

post operative tlso trunk orthosis sagittal profile brace by ortholutions

Fig. 8 Patient with scoliosis after removal of stabilising implanted devices due to incompatibility. The improvement of the sagittal statics and the associated more physiologic shape of the sagittal profile are clearly visible. Result: The pain has significantly decreased and, in addition, the orthosis ensures an external stabilisation of the lower lumbar spine

These properties are particularly useful in the postoperative field of application and for pain therapy.

Practical advantages

Highly functional modules offering a large field of application are available to orthopaedic technicians.

The excellent biometrical design excels by its uncomplicated and well thought-out nature while offering unrestricted functionality.

The orthosis modules are exclusively made of elements that are required in order to attain the function of the respective area of indications.

Thanks to the specific tailoring, all types of orthoses can be adjusted exactly, at any time and individually with regards their function.

The double-cup systems of the series are particularly suitable for adjusting the ideal correction pressure. The ventral and dorsal cups are adjusted exactly in A-P direction during the fitting to the patient. After a certain system learning phase the orthosis modules also allow for the realisation of complex fittings.

Time saving constitutes another important factor. The measuring and fitting times are clearly reduced for the patient. Moreover, considerably less time is needed for modification and rework. Other areas of competence and free spaces can be extended or deepened thanks to the time saved.

trunk orthoses tlso for sagittal profile back pain management

Fig. 7 Orthosis for lordosing in case of marked flattening of the vertebral column and associated pain. Upper row: Planning of fitting. The orthosis is in its raw condition covering the pelvis and shows large material reserves in order to ensure individuality and versatility for tailoring and thus functionality. Lower row: completed orthosis

Conclusion

The Ortholutions trunk orthosis system constitutes a useful technology to essentially increase efficiency for specialised companies.

In particular for orthopaedic technical companies that do not have much experience in complex trunk orthoses, trunk orthosis systems constitute a useful addition and possibility of extension of their range of fittings.

The on-site service offered by the manufacturer is useful. The approach guarantees maximum safety of fitting and the technical support of the competence team of the manufacturer.

Since no plaster cast is required and the modules are supplied ready for fitting, the fitting system has proven successful for home visits and in particular for fittings performed in hospitals.

The Ortholutions trunk orthosis system contributes to an appropriate and professional service to the patient.

 

The author:

Dino Gallo, CPO, Ortholutions 

 

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