From: Spine (Phila Pa 1976). 2010 May 4. [Epub ahead of print]
Fluoroscopic assessment of the effects of commercially available spinal orthotics on lumbar vertebral motion as subjects performed flexion and extension maneuvers. To quantitate the effects of 3 commonly available, off-the-shelf, soft, and semirigid spinal orthoses on lumbar spinal motion.
Commercially available soft and semirigid orthoses are widely prescribed for patients with low back pain and, at times, following surgery. Despite this use, surprisingly little is known about the magnitude of their effects on lumbar vertebral motion.
Ten subjects (6 men and 4 women) with an average age of 27.0 +/- 5.3 years, underwent videofluoroscopic imaging as they performed a full flexion/extension cycle. Assessments, during which the subjects were unbraced or wearing either a soft lumbrosacral orthosis, a semirigid lumbrosacral orthosis, or a semirigid thoracolumbrosacral orthosis were performed in random order. Images were obtained at a rate of 3.75 Hz and digitally processed to determine the sagittal rotation of the L3-L5 vertebral bodies.
Each of the braces produced a statistically significant reduction in overall lumbar motion during the flexion maneuver but none had a detectable effect during extension. Relative effectiveness varied by vertebral level. At the L3-L4 level, only the semirigid thoracolumbrosacral orthosis had a statistically significant effect on intervertebral flexion movement (32%). At the L4-L5 level all the orthoses were effective (and statistically indistinguishable) in their ability to reduce intervertebral flexion movements ranging from 48% for the semirigid thoracolumbrosacral orthosis to about 15% to 20% for the 2 lumbrosacral orthoses. No effects were noted for any of the orthoses at the L5-S1 level.
From: Spine (Phila Pa 1976). 2004 Jan 1;29(1):100-4.
Lumbar spine stabilization with a thoracolumbosacral orthosis: evaluation with video fluoroscopy.
In this study, L3-L5 vertebral body motion was tracked fluoroscopically as individuals performed flexion-extension movements wearing different thoracolumbosacral orthoses. To assess the effect of custom fitted thoracolumbosacral orthoses on lumbar vertebral body motion.
Several methods have been used to evaluate dynamic vertebral motion in vivo. Controversy remains regarding the utility of a thoracolumbosacral orthosis in decreasing intervertebral motion in the lumbar spine. Dynamic motion of the vertebral bodies was assessed fluoroscopically under four conditions: without a brace, with a custom fitted thoracolumbosacral orthosis, with the thoracolumbosacral orthosis 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.
The thoracolumbosacral orthosis 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 thoracolumbosacral orthosis. 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 thoracolumbosacral orthosis and an additional 15% when a thigh extender was added.
In this study, a custom molded thoracolumbosacral orthosis reduced both total L3-L5 motion and intervertebral motion in the lower lumbar spine. These effects are enhanced if a thigh extender is used.
Sources: Bracing For Low Back Pain
