Flexible spinal orthoses such as corsets and belts are commonly used in the treatment of back problems.
Following types of flexible spinal orthoses are used.
Sacroiliac Belt
This is a prefabricated belt 5.1 cm to 10.2 cm (2- 4 in.) wide which encircles the pelvis between the iliac crests and the trochanters. Perineal straps may be provided to prevent upward displacement.
Sacroiliac belt stabilizes sacroiliac joints.
It is used in postpartum and posttraumatic sacroiliac separations.
Sacroiliac Corset
It is a prefabricated cloth garment that encompasses the pelvis and is adjustable in circumference by means of the side, front, or back laces or hooks. Anteriorly and posteriorly, the superior border is at iliac crest level. Anteriorly, the inferior border is 1.3 cm to 2.5 cm above the pubic symphysis and posteriorly it extends to the apex of the gluteal bulge. For cosmetic reasons, the superior border may rise to just above waist level, and the inferior border may descend to the gluteal fold, thus reducing bulging
While not effective restricting motion, this orthosis may assist in elevating intraabdominal pressure and may be useful for postpartum and posttraumatic stabilization of pelvic joints
Additions may include posterior rigid or semirigid stays, posterior sacral pad, and perineal straps.
Lumbar Binder
This is a simple prefabricated orthosis, made fabric with elastic sections, is wrapped around the lumbar region and het in place by Velcro closure.
It provides trunk support and supports the elevation of intraabdominal pressure. It also serves to remind the patient of proper posture.
To provide increased support, a Low-temperature thermoplastic inserted into a posterior pocket.
Lumbosacral Corset
It is the most commonly used flexible orthosis made of a cloth garment that encompasses the torso and his and is adjustable circumferentially by means of side front or back laces. Anteriorly the superior border is about half inch below xiphoid process.
The inferior border is half to one inch above the pubic symphysis.
Posteriorly, the superior border is one inch below the inferior angles of scapulae and the inferior border is just below the apex of the gluteal bulge for men and at the gluteal fold women.
The corset is usually prefabricated and may require alteration for proper fit.
If a prefabricated garment can’t be used, a custom corset may be fabricated, based upon a pattern derived from measurements of the individual patient.
The anterior and lateral trunk containments of the orthosis elevate intracavitary pressure, thus decreasing the loadings on the vertebrae and discs.
Depending on the number, placement, and rigidity of the vertical stays, three-point pressures are applied which tend to restrict spinal motion. In all cases, the corset serves as a reminder to restrict motion. It provides restraint to flexion, extension and lateral flexion but fails to control the rotation.
Necessary additions, depending on the need of the patient may include
- Posterior rigid or semirigid stays
- Posterior pads
- Extra-abdominal reinforcements
- Hose supporters
- Perineal straps
- Thoracic extension with shoulder straps.
The thoracic extension converts the lumbosacral corset to the thoracolumbosacral type.
Posterior stays should be shaped so as to flatten ( not maintain) lumbar lordosis.
Thoracolumbosacral Corset
This flexible orthosis is a cloth garment that encompasses the torso and hips and is adjustable in circumference by means of side, front, or back laces, buckles, or hooks.
The anterior borders are generally the same as those of the lumbosacral corset. Alternatively, the anterosuperior border may terminate just below the costal margin.
Posteriorly, the superior border is approximately at the level of the scapular spines, and the inferior border is just below the apex of the gluteal bulge for men and the gluteal fold women. Shoulder straps encircle the axillae, cross posteriorly, and fasten anteriorly.
The corset is usually reinforced with posterior rigid or semirigid stays extending the full length of the orthosis. The corset, usually a prefabricated garment, should fit all body contours snugly.
The corset offers the following functions
- Trunk stabilization
- Elevates intracavitary pressure to decrease loadings on vertebrae and discs.
- Restrict spinal motion. In all instances, the corset serves as a reminder to restrict motion. The orthosis provides a restriction to flexion and extension mainly. Lateral flexion and rotation are less affected.
Optional additions include posterior pads, extra abdominal reinforcement, hose supporters, and perineal straps.
Shoulder straps should be padded to prevent discomfort in the areas of the axillae and superior surface of the shoulders.
