Comparing Spinomed® and Elderly Spinal Orthosis Use on Kyphosis Angle, Back Pain, and Quality of Life in Elderly With Thoracic Hyperkyphosis

Objectives: Thoracic hyperkyphosis is one of the most common conditions in the elderly. The use of orthosis and exercise is one of the most effective treatments suggested, but unfortunately, there is little evidence to support this treatment. The study aimed to compare the effect of Spinomed® orthosis and elderly spinal orthosis with exercise and exercise alone on the angle of kyphosis, quality of life, and pain in the elderly with thoracic hyperkyphosis. Methods: In this study, 40 older adults aged 60 years and older with a kyphosis angle of more than 50 degrees were recruited. The participants were allocated into three groups: Spinomed® orthosis and exercise (n=14), elderly spinal orthosis and exercise (n=15), and exercise only (n=11). The groups were treated for three months. Results: There was a significant decrease in the kyphosis angle of participants in the Spinomed® orthosis and exercise groups (P=0.005). Pain score was significantly decreased in the Spinomed® orthosis and exercise group (P=0.023). There was only a significant increase in the physical component summary in the Spinomed® orthosis and exercise group (P=0.03) and the elderly spinal orthosis and exercise group (P=0.04) . Discussion: The combination of Spinomed® orthosis with exercise is the best choice to correct the kyphosis angle, reduce pain, and increase the quality of life. Elderly spinal orthosis and exercise can also improve the quality of life scores.

An effect of spinal and ankle-foot orthoses on gait of spastic diplegic child: A case report

BACKGROUND: In children with spastic cerebral palsy (CP), the most common motor dysfunction is pathological gait. OBJECTIVE: To evaluate the effectiveness of measures for an individual CP case. METHODS: The case of one spastic diplegia child has been analyzed. Both lower extremities and spine were examined under three gait conditions: 1) barefoot, 2) with ankle-foot orthoses (AFOs) and thoracolumbosacral spinal orthosis (TLSO), and 3) with TLSO only. Spatiotemporal gait and kinematic parameters of the pelvic, hip, knee, ankle joints, and spine were obtained using Vicon Plug-in-Gait model. The difference (Δ) between the measured values and normative ranges was calculated to determine the efficiency of the orthoses. RESULTS: Significant differences were found in kinematic and spatiotemporal parameters comparing results between conditions and body sides. The effectiveness of the measures was confirmed by the smallest Δ values in the double and single support time with the AFOs/TLSO and in the stride and stance time with TLSO. CONCLUSIONS: Based on the study results, the best stability of the spine, ankle plantarflexion, and knee hyperextension is achieved with the AFOs/TLSO; therefore, this combination of measures was considered the most effective. However, not only quantitative parameters should be taken into account, but also the child’s willingness and comfort.

Spinal Orthoses Prescription for Vertebral Fragility Fractures by Italian Physical and Rehabilitation Medicine Physicians: The SPIN-VER Survey

Vertebral fragility fractures (VFFs) are the most common type of osteoporotic fractures, related to pain and disability. In this scenario, physical and rehabilitative medicine (PRM) physicians prescribe a patient-tailored rehabilitation plan, including spinal orthoses. However, there is a high heterogeneity in the clinical indications of spinal orthoses. Thus, the aim of this survey was to investigate common clinical practice in terms of the prescription of spinal orthoses. This nationwide cross-sectional survey recruited Italian PRM physicians commonly involved in the management of patients with VFFs. One hundred twenty-six PRM physicians completed the survey. The results showed that most PRM physicians prescribe spinal orthoses in outpatients suffering from VFFs (n = 106; 83.9%). The most prescribed spinal orthosis for acute VFF patients was the three-point rigid orthosis (n = 64; 50.8%), followed by the semirigid thoraco-lumbar orthosis (n: 20; 15.9%). However, most PRM physicians prescribed dynamic orthoses in outpatients with chronic VFFs (n = 66; 52.4%). Albeit that a correct management of VFFs is mandatory to improve pain and reduce disability, our findings highlighted uncertainty in the type of spinal orthosis prescription in both the acute and chronic VFF phase. Therefore, high-quality research trials are warranted to provide clear recommendations for the correct clinical management of VFF.

Postoperative spinal orthosis may not be necessary for minimally invasive lumbar spine fusion surgery: a prospective randomized controlled trial

Background With the progress and success in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF), the musculoskeletal injury was minimized. However, the role of postoperative orthosis in MIS TLIF has not been established and there is little evidence supporting the routine use of orthosis in MIS TLIF. Methods This is a prospective randomized clinical study. 90 patients who underwent MIS TLIF were randomly divided into groups A (with postoperative spinal orthosis) and B (without postoperative spinal orthosis). Patients were followed up for an average of 12.6 months. Clinical outcome was assessed using the Oswestry disability index (ODI) and visual analogue scale (VAS). Fusion rate was classified with the BSF scale system at postoperative 6-month, and 12-month. Results Both groups had similar patient demographics. The use of postoperative spinal orthosis had no significant influence on instrumentation-related complications or radiological parameters at each follow-up. Conclusions In this study, we conclude that postoperative spinal orthosis is not necessary for MIS TLIF. Patients without postoperative spinal orthosis had the same fusion rates and improvement of VAS and ODI scores.

An Indigenous Design for Management of Congenital Scoliosis - A Case Study

Introduction: Available orthotic brace options for Congenital scoliosis are a few and are quite cumbersome to be tolerated by infants. Considering comfort, acceptance, and effectiveness, we have designed and developed a new spinal Orthosis, incorporating a flexible strap system. The purpose of this study was to investigate the effect of this novel flexible spinal Orthosis on scoliotic curve correction and progression. Methods: A 1-year-old female infant diagnosed with congenital Scoliosis was fitted with the novel flexible spinal orthotic brace to control the curve progression and to maintain an upright posture. The anterior-posterior radiographs were analyzed for measuring the Cobb angle. The plumb line test was used to assess the postural improvements. Before and After tests were conducted with and without the Novel spinal brace with an intervention period of 2 months. Discussion: The Cobb’s angle was found to be 7˚ less after the intervention period of 2 months. There was also a marked improvement in Body posture with a 6mm plumbline shift towards the midline. This indigenous flexible spinal brace can be considered as a new, effective method for the treatment of Congenital Scoliosis and it also can be used for maintaining an aligned posture. Key words: Congenital Scoliosis, Flexible spinal Brace, Cobb’s angle.

Rehabilitation therapy for patients with osteoporosis

Fractures in patients with osteoporosis are attributable to falls and reduced bone mass. Therefore, balance and muscle strength should be improved and bone mass should be increased to prevent fractures. This study aims to investigate a rehabilitation treatment for osteoporosis. Exercise is a potentially safe and effective way to increase bone density and prevent postmenopausal bone loss. Based on bone densitometry results, rehabilitation exercises can be applied variably. Fractures caused by osteoporotic fragility may be prevented with multidisciplinary intervention programs including education, environmental modifications, aids, and individually tailored exercise programs. In addition, strengthening the paraspinal muscles may not only maintain bone mineral density but also reduce the risk of vertebral fractures. Rehabilitation after vertebral fractures includes proprioceptive dynamic posture training that decreases kyphotic posturing through the recruitment of back extensors. This training reduces pain, improves mobility, and leads to a better quality of life. Hip fractures may be prevented by hip protectors and exercise programs that can improve the strength and mobility of patients with hip fractures. Considering the musculoskeletal condition, the spine should be protected using a spinal orthosis, taping, hip pad, and walking aid, if necessary. Efforts to activate programs such as fracture liaison services should also be considered.

Review of Current Spinal Robotic Orthoses

Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery.