Experience with an Orthosis for the Care of Postoperative Spinal Deformities
WILLIAM J. BARRINGER, MS, CO*,GARY S. TREXLER, CO*, ANDWILLIAM A. HERNDON, MD**Oklahoma City, Oklahoma
Recent advances, including segmental instrumentation and anterior fusion with or without instrumentation, have improved correction and stabilization of spinal deformities1. These techniques have decreased or eliminated the need for postoperative immobilization in some patients. Other patients would, however, benefit from a period of external immobilization following surgical correction and stabilization. In our experience, this group has included patients with idiopathic scoliosis who have undergone posterior fusion with Harrington instrumentation as well as those with certain neuromuscular deformities.
We have had success recently with a total-contact thoracolumbosacral orthosis (TLSO) for those patients.
The postoperative TLSO is fabricated from either polypropylene or, for special cases, polyethylene with an Aliplast liner2-5. Polypropylene is preferred because of its rigidity and resistance to fatigue, while polyethylene with an Aliplast liner suits children who are apt to develop skin problems, such as for spina bifida or cerebral palsy patients.
The orthosis has anterior and posterior sections with Velcro closures (Figs. 1 and 2 ). Three to seven days following surgery an impression is taken on the Chick RS casting frame. Standard cast-modification procedures are then completed and the selected plastic is vacuum-formed. The TLSO is fitted 24 to 36 hours later and the patient is referred to the physical therapy department for sitting or ambulation as appropriate. The patient is then followed jointly by the orthopedic and orthotic services in the spinal deformities clinic where necessary adjustments and maintenance are performed.
For further details on TLSO fabrication contact the senior author.
Twenty-seven patients have worn the TLSO: 16 with idiopathic scoliosis, five with spina bifida, two with scoliosis from spinal cord injury and one each with muscular dystrophy, cerebral palsy, congenital scoliosis and congenital lumbar kyphosis. The patients had fusions extending from as high as the second thoracic vertebra to as low as the sacrum.
At this review, 10 of the idiopathic scoliosis patients have completed a six month course in the orthosis and were felt to be healed. Two of the idiopathic scoliosis patients were noncompliant for personal reasons while the remaining four patients were still in the TLSO.
The eight children with neuromuscular spinal deformity were all in the orthosis at the time of writing and experienced no TLSO-related problems.
The remaining two patients with congenital spinal deformity were still maintained in their orthoses without problems.
With this short-term follow-up there have been no unexpected losses of correction or instrumentation failure. No patient has had to discontinue use of the Postoperative Spinal Deformities orthosis because of severe skin problems or intolerable discomfort. One patient with spina bifida has remained in his orthosis almost three years without difficulty,
The need for immobilization following stabilization of spinal deformities depends on the deformity, instrumentation used and beliefs and experience of the surgeon. The most secure forms of spinal instrumentation involve sublaminar wiring and carry a risk of neurologic injury that may be unacceptable to some surgeons and in some patients. We believe that the TLSO provides adequate postoperative support in those circumstances. It is lightweight, easily and quickly fabricated, and can be easily removed for hygiene and skin inspection.
Our patients have accepted the orthosis and we feel it provides satisfactory support for the postoperative spinal-deformity patient.
*Department of Orthotics
**Department of Orthopaedic Surgery and Rehabilitation, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73126
- Herndon, W. A.: Spinal Deformities in Children. Postgrad Med 76:67-76, 1984.
- Roberts, R. S., C. T. Price and M. F. Reddick: Use of a Bivalved Polypropylene Orthosis in the Postoperative Management of Idiopathic Scoliosis. Clin Orthop 185:25, 1984.
- Stills, M. and A. B. Wilson: A New Material in Orthotics and Prosthetics. Orthot Prosthet 34:29-37, 1980.
- Wallace, S. L., and K. Fillauer: Thermoplastic Body Jackets for Postspinal Fusion Patients with Scoliosis. Orthot Prosthet 33:20-24, 1979.
- Winter, R. B. and J. M. Carlson: Modern Orthotics for Spinal Deformities. Clin Orthop 126:74-86, 1977.