Effectiveness of three types of lumbar orthosis for restricting extension motion

Effectiveness of orthoses for treatment in patients with spinal pain

Spinal pain is a common patient complaint in clinical practice. Conservative treatment methods include oral medication, physical therapy, injections, and spinal orthoses. The clinical application of orthoses is debated because of potential complications associated with long-term use, such as muscle weakness and joint contracture. We reviewed the orthoses most frequently used to manage spinal pain. We review the use of soft cervical and Philadelphia collars, lumbosacral corsets, and thoracolumbosacral orthosis to manage spinal pain. Spinal orthoses can help reduce pain by protecting the muscles and joints of the injured spinal region, preventing or correcting malformations, and limiting trunk flexion, extension, lateral flexion, and rotation. The short-term use of spinal orthoses is known to improve pain and disability during the treatment period without significant adverse effects. Spinal orthoses are expected to alleviate pain and improve patients’ lifestyle.

A semi-rigid thoracolumbar orthosis fitted immediately after spinal surgery : stabilizing effects and patient satisfaction

Purpose : To evaluate the stabilizing effects of a Fit Cure-Spine® semi-rigid thoracolumbar orthosis and wearer satisfaction after lumbar surgery. Methods : In study 1, the spinal angle, spinal motion angle, and distribution of load were measured in 8 adult male volunteers when the orthosis was worn (1) with no custom-made stay (CMS), (2) with a CMS in the prone position (P-CMS), and (3) with a CMS in the prone position and decreased lordosis (DP-CMS). In study 2, pain scale scores and responses to a questionnaire were recorded in 40 consecutive patients who underwent lumbar spinal surgery in our hospital. Results : In study 1, the mean lumbar lordosis when standing was similar to that in the prone position. When the trunk was bent forward, loads on the back support in P-CMS and DP-CMS were concentrated at the center of the CMS, unlike those for No-CMS. In study 2, there was a significant decrease in postoperative wound pain after wearing the Fit Cure-Spine orthosis for 2 weeks. Most patients who wore the orthosis were satisfied with their pain outcome. Conclusion : Adjustment to lumbar lordosis and the prone position was restricted in volunteers wearing the Fit Cure-Spine with a CMS. J. Med. Invest. 66 : 275-279, August, 2019.

What Type of Orthosis is Optimal for Conservative Treatment of Lumbar Spondylolysis?: A Biomechanical Analysis

Introduction

To analyze the extent to which various types of orthoses can restrict motion of the lumbar spine and provide basic evidence regarding the optimal orthosis for conservative treatment of lumbar spondylolysis (LS), particularly. Although several orthoses have been developed and applied for LS with better outcomes for bony healing, basic data regarding which is optimal are still lacking.

Methods

Ten healthy voluntary participants were included in this study. Lumbar spine range of motion (ROM) was analyzed using a three-dimensional motion capture system (NEXUS 2.2, Vicon Motion Systems Ltd., UK) under five conditions wearing no orthosis (NB) and four types of lumbar-sacral orthoses (LSO): custom-made hard LSO (HO), soft LSO supported by four aluminum stays and a custom-molded back cast-panel named "Return to Sports" braces (RS), custom-made soft LSO known as Damen type elasticity corset (DC), and off-the-shelf soft LSO.

Results

HO showed the highest restriction of motion in all directions than the others. Especially, ROM of rotation and side bending were reduced to 58.3% and 63.6% compared with NB, respectively. The other three LSOs showed significantly higher restriction in extension, rotation, and side bending than NB. In flexion and side bending, DC showed significantly higher restriction than NB.

Conclusions

HO showed high restriction in all directions. RS showed higher restriction in extension than NB and less restriction in flexion and side bending than other custom-made LSOs. DC was the only soft LSO showing higher restriction than NB in flexion.

Effectiveness of lumbar orthoses in low back pain: Review of the literature and our results

Back pain and diseases of the spine are today a health disorder of outstanding epidemiological, medical, and health economic importance. The cost of care for patients with lumbosciatic complaints are steadily increasing. Accordingly, the guidelines and treatments are constantly renewed. One concept is the orthotic care. In the following we want to give an overview of the literature and the effectiveness of lumbar orthoses in low back pain supplemented by our own data. A prospective randomized study with 230 patients, divided into three groups, each with two subgroups. Three Orthoses by the TIGGES-Zours GmbH were prescribed; a demountable two-step lumbar orthosis, three-step bridging orthosis and a four-step flexion orthosis modular system. Each were compared to the nonmodular equivalent. All six groups showed improvement in pain intensity and functional capacity at 6 and 12 weeks. The modular groups were found to have improvement in the frequency of use. The subjective effectiveness and sensitivity for the modular and non-modular groups was assessed as being good. In the literature, there are no clear guidelines for an orthotic supply. The studies do not seem to be meaningful and universal due to the difficult ascertainability of pain. There is a need for further research here. Nevertheless, the authors of this review are of the opinion that the implementation of trunk orthoses is void of side effects and beneficial to patients. The modular systems seem to have an advantage as well as higher patient satisfaction.

State-of-the-art management of low back pain in athletes: Instructional lecture

In this paper, we describe "state of the art" on the diagnosis and treatment for low back pain in athletes. Lumbar motion that induces specific pain would be a clue to the exact diagnosis. In the flexion pain group, lumbar herniated nucleus pulposus is the most common disorder. Discogenic pain and type 1 Modic endplate inflammation may also cause flexion pain; however, the diagnosis is sometimes difficult. In children and adolescents, apophyseal ring fracture is prevalent. In the extension pain group, lumbar spondylolysis is very common, especially in pediatric athletes. In adults, facet pain due to overloading would be the pathology, while low back pain with trunk rotation is not common. However, throwing athletes, such as pitchers and hammer throwers, may experience this kind of pain; facet arthritis contralateral to the throwing arm would be the origin of the pain. Low back pain on lumbar lateral bending is rare, but we experienced some cases in golfers in whom type 1 Modic change at the lateral corner was the source of pain. In this article, we explained strategies for state-of-the-art diagnosis and minimally invasive treatment.

The effects of stabilization exercise with an oral assistive device on pain and functionality of low back pain patients

[Purpose] This study examined low back pain patients’ decrease in pain and improvement in functionality after performance of a lumbar stabilization exercise using an oral assistive device, which can replace a lumbar assistive device. [Subjects and Methods] The experimental group (n=12) conducted a stabilization exercise using an oral assistive device after conventional physical therapy. The control group (n=12) received conventional physical therapy. In order to objectively measure pain in this study, a visual analogue scale (VAS) was used. In order to evaluate the subjects’ functional aspects while living with low back pain, the Oswestry Disability Index (ODI) was used. [Results] There were statistically significant improvements in the comparison of the VAS and ODI of the experimental group and the control group. The experimental group’s VAS and ODI significantly improved after the intervention compared to the control group. [Conclusion] The stabilization exercise using the assistive device after conventional physical therapy in the rehabilitation of low back pain patients reduced subjects’ pain and increased their functional activities.