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Introduction to Spinal Orthotics

Anatomy of the Spine
Spinal Orthotics
Lectures
2011.10.27 15:45-17:45
1.Introduction & Anatomy
2.Physiology & Biomechanics of the Spine
3.Pathologies Affecting the Spine
4.Variations of Orthotic Design
2011.10.28 8:00-9:30, 9:45-11:45
1.Patient assessment and Treatment Process
2.Custom Orthoses Casting & Fabrication process
3.Pre-Fabricated Orthoses Measurement & Fitting
4.Case based learning
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Overview
Introduction to Spinal Orthotics
Regions and curvature of the spine
Bones of the vertebral column and thoracic cage
Structure of the different vertebrae
Columns of the spine
IVDs, ligaments, spinal nerves and muscles of the spine
Movement at the spine
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This is just an INTRODUCTION to spinal
orthotics
Treating spinal conditions usually means specializing
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Indications for Spinal Orthoses
Pain relief
Mechanical unloading
Correction of Pathological position (i.e. Scoliosis, kyphosis,
spondylolisthesis, etc.)
Spinal immobilization after surgery
Spinal immobilization after traumatic injury
Compression fracture management
Kinesthetic reminder to avoid certain movements
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Positive Outcomes:
Decreased pain
Improved function/trunk support/motion control
Increased proprioception
Improved posture/ spinal realignment
Correction of spinal deformity
Protection against spinal instability
Healing of ligaments and bones
Increase in intra-abdominal support
Ease muscle strain
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Possible Negative Outcomes:
Muscle atrophy with prolonged use
Decreased pulmonary capacity
Increased energy expenditure with ambulation
Difficulty donning and doffing orthosis
Difficulty with transfers
Psychological and physical dependency
Increased segmental motion at ends of the orthosis
Poor patient compliance
Local pain /Skin breakdown/Discomfort
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Type of Spinal orthosis
Cervical orthoses (CO)
Lumbo-sacral orthoses (LSO)
Thoraco-lumbo-sacral orthoses (TLSO)
Cervico-Thoraco-lumbo-sacral orthoses (CTLSO)
Sacro-iliac orthoses (SIO)
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Anatomy of the spine
Regions of the spine
Development of curvature
Bones of the spine
The vertebral column
Structure of vertebrae
Columns of the spine
The thoracic cage
IVDs, ligaments, spinal nerves and muscles of the spine
Movements of the spine
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Regions of the spine
5 different regions
Cervical
Thoracic
Lumbar
Sacral (sacrum)
Coccygeal (coccyx)
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Curvature of the spine
Lordosis anterior convexity
Kyphosis anterior concavity
Scoliosis lateral curvature
(typical)
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Curvature of the spine
Primary curve all kyphosis
1st secondary curve cervical
lordosis
2nd secondary curve lumbar
lordosis
Flattens out with old age
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Bones of the trunk
Vertebral column (spine)
Thorax (sternum and ribs)
Shoulder girdle (clavicle and
scapula)
Pelvic girdle (not shown)
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The vertebral column
Base of skull to pelvis
24 individual vertebrae plus
sacrum and coccyx
7 cervical
12 thoracic
5 lumbar
5 fused sacral
5 fused coccygeal
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Structure of the vertebrae
Different levels/regions have
different shapes and structure
All (except C1/C2) have
1. Body
2. 2 pedicles
3. 2 lamina
4. Neural canal
5. Spinous process
6. 2 lateral processes
7. Facet joint for articulation
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1
7
2
6
4
5
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Cervical Vertebrae C1 Atlas
Ring of bones
No body
No spinous processes
Small transverse process
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Cervical Vertebrae C2 Axis
Odontoid process acts as axis/ pivot
Small neural canal
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Cervical Vertebrae
7 cervical vertebrae
C1 (Altas) and C2 (Axis)
different to others
Small
Transverse foramen
Bifid spinous processes
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Thoracic Vertebrae
12 thoracic vertebrae
Articulate with ribs
Spinous process long and
angled inferiorly
Body shaped like a heart
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Thoracic Vertebrae
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Lumbar Vertebrae
5 Lumbar vertebrae
Very large body
Spinous process is straight,
short, and horizontal
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Lumbar Vertebrae
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Columns of the spine
3 column spine
Anterior
Middle
Posterior
Reference for injury/fractures
One column injured, other
two may protect spinal cord.
If two columns injured,
increased chance of spinal
injury
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The Thoracic Cage
12 ribs
Clavicles
Sternum
Munubrium
Body
Xiphoid process
Thoracic vertebrae
Protects internal organs
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The Intervertebral Discs
24 IVDs
Act as a cushion
Between vertebral bodies
Shock absorbers
Get bigger as they progress
inferiorly
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Ligaments around the spine
Lots of ligaments dont
remember names, just function
Connect vertebrae
Stabilise the spine
Control movement
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Muscles of the Spine
Many muscles with a
complex structure
Important to understand
movements and muscle
groups
We will NOT cover exact
details of each muscle
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Movement of the Spine
Influenced by all structures of
the spine
One main function
Control motion so
excessive movements do
NOT occur
Flex/Ext, Lat flexion and
rotation
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Movement of the Spine
Movement occurs in regions so it is difficult to measure ROM at
specific levels
Well look at ROM of each region as a unit
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Movement at the Cervical Region
The following are approximate
C1-skull
Flex/ext 20 degrees
C2-C1
Rotation 15 degrees in each
direction
C2-T1
Flexion 25 degrees
Extension 85 degrees
Rotation 50 degrees in each
direction.
Lateral flexion 40 degrees each side
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Movement at the Thoracic Region
The following are
approximate
Flexion 30-40 degrees
Extension 20-30 degrees
Lateral flexion 20-25 degrees
Rotation 35 degrees in each
direction
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Movement at the Lumbar Region
The following are
approximately
Flexion 55 degrees
Extension 30 degrees
Lateral flexion 20-30 degrees
No Rotation
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Spinal nerves
31 pairs
Named according to what
vertebra they originate from
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Useful landmarks
C7- prominence
T3 Scapular spine
T7 - Inferior scapula
T9 - Xiphoid process
L4 - Illiac crest
S2 - PSIS
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Summary
Regions of the spine
Development of curvature
Bones of the spine
The vertebral column
Structure of vertebrae
Columns of the spine
The thoracic cage
IVDs, ligaments, spinal nerves and muscles of the spine
Movements of the spine
This subject is an introduction!
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On Your Own
Using the skeleton, look at the differences between vertebrae of
different regions
Using anatomy books, look at the muscles acting on the spine.
Try to locate these on your classmates
List the bones that make up the Thoracic cage. List what
internal structures/organs this protects
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any questions?
Thank You