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Lumbar spine stabilization with a thoracolumbosacral orthosis: evaluation with video fluoroscopy
Douglas Vander Kooi1, Gregory Abad, Jeffrey R Basford
1Mayo Medical School, Rochester, MN, USA.
Study Design:
L3-L5 vertebral body motion was tracked fluoroscopically as individuals performed flexion-extension movements wearing different thoracolumbosacral orthoses (TLSOs).
Objective:
To assess the effect of custom fitted TLSOs on lumbar vertebral body motion.
Summary Of Background Data:
Several methods have been used to evaluate dynamic vertebral motion in vivo. Controversy remains regarding the utility of a TLSO in decreasing intervertebral motion in the lumbar spine.
Methods:
Dynamic motion of the vertebral bodies was assessed fluoroscopically under four conditions: without a brace, with a custom fitted TLSO, with the TLSO and thigh extender at 0 degrees or 15 degrees. Intervertebral motion, i.e., the rotation of one vertebral body with respect to the adjacent body in the sagittal plane, throughout the flexion-extension cycle was used to assess the effect of each condition.
Results:
The TSLO reduced both the total L3-L5 range of motion and the intervertebral motion at each individual level. Total rotation at L3 with respect to horizontal was reduced from 70 degrees without a brace to 50 degrees with a TLSO. Use of the thigh extender provided an additional reduction to 10 degrees. There was no difference between the 0 degrees and 15 degrees settings. Intervertebral motion was reduced by 40% at both L3-L4 and L4-L5 when comparing no brace to TLSO and an additional 15% when a thigh extender was added.
Conclusions:
A custom molded TLSO reduces both total L3-L5 motion and intervertebral motion in the lower lumbar spine. These effects are enhanced if a thigh extender is used.
