Spinal Braces

Braces

 

1.  Motion Control

 

2.  Spinal Realignment

 

3.  Trunk Support

 

4. Weight Transfer

 

Soft Collar

 

Cheap & Comfortable

- ineffective

- allows 70% Flexion Extension / 80% Rotation / 90% Lateral bend

 

Philadelphia Collar

 

Better than soft collar but less comfortable

- allows 35% Flexion Extension / 40% Rotation / 60% Lateral bend

- excellent immobility in acute situation when combined with sandbags & forehead tape

 

SOMI Brace

 

Sterno-Occipital Mandibular Immobilizer

- effective control C1/2 & C2/3

- allows 30% Flexion Extension / 30% Rotation / 60% Lateral bend

 

Yale Brace

 

Cervico-Thoracic Brace

- Philadelphia Collar but with chest extension & strap 

- best of conventional braces

- allows 10% Flexion Extension / 50% Rotation / 25% Lateral bend

 

Halo-Thoracic Brace (HTB) / Halo Vest

 

Indication

 

External immobilization for upper cervical spine injuries

- occipital condyle fractures

- stable C1 / atlas fractures

- C2 fractures include odontoid fractures

- C1 C2 instability

 

Less effective for subaxial spine

 

Contra-indications

 

Elderly

 

Horn et al J Neurosurg Spine 2006

- 53 patients > 70 treated with HTB

- 6 patients (14%) died of respiratory distress related to HTB

 

Majercik et al J Trauma 2005

- compared HTB in 129 old patients (average age 80)

- 289 young patients (average age 40)

- mortality rate 40% in old versus 2% in young

 

Effectiveness

 

Restricts atlanto-axial flexion / extension by 75%

 

Banat et al Eur J Trauma Emerg Surg 2022

- systematic review of HTB in pediatric population

- high success rates with only minor complications

 

Pin safe zones

 

Frontal cranium

- above lateral 2/3 of the orbital rim / eyebrow

- 1 cm above top of ears

- medial to this zone is supraorbital nerve and frontal sinus

 

Technique

 

Halo-thoracic brace technique

 

Halo vest 1Halo vest 2

 

Vest

- roll patient on side in controlled manner

- fit posterior chest brace

- roll back, apply anterior chest brace, tighten

 

HTB 1HTB 3HTB 4

 

Halo

- size halo around maximum diameter of skull

- should have 1 - 2 cm gap from skull

- sits 1 cm above pinna and eyebrows

- 4 pins

- 2 above pinna, 2 above upper and outer eyebrow

- can shine torch through holes to mark sites of pins

- local anesthetic to sites

- must close eyes before supraorbital pins to avoid problems closing eyes

- tighten to 8 pounds / square inch

- often come with snap lock pins

 

HTB XrayHalo CT

 

Complications

 

Malnik et al Br J Neurosurg 2021

- 67 patients mean age of 52 treated with HTB

- 25% pneumonia initial hospital stay

- 22% loose pins

- 18% pin site infections

 

Gardner Wells Tongs

 

Gardner wells tongs 1Gardner wells tongs 1Gardner wells tongs 3

 

Indications

 

Cervical traction - i.e. rotatory atlanto-axial subluxation

Reduction of acute facet joint subluxations / dislocations

Patient positioning during spine surgery

Skeletal traction during deformity correction such as scoliosis surgery

 

Technique

 

Pin insertion sites as per HTB

 

Results

 

Saleh et al J Spine Surg 2018

- complication rate generally low

- superficial infection, pin loosening, asymmetrical pin positioning

- major complication such as skull perforation, brain abscess rare

 

Thoraco - Lumbar Orthosis / TLSO

 

Types of TL Orthosis

1. TLSO

2. Three point brace

3. Moulded Body Jacket

 

CTLSO / Milwaukee

 

TLSO with neck brace

 

For lesion with apex above T8