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.
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.
Authors: Peter G Passias; Shaobai Wang; Michal Kozanek; Qun Xia; Weishi Li; Brian Grottkau; Kirkham B Wood; Guoan Li Journal: J Bone Joint Surg Am Date: 2011-01-05 Impact factor: 5.284