Lumbar spine stabilization with a thoracolumbosacral orthosis: evaluation with video fluoroscopy.

Abstract

L3-L5 vertebral body motion was tracked fluoroscopically as individuals performed flexion-extension movements wearing different thoracolumbosacral orthoses (TLSOs). To assess the effect of custom fitted TLSOs on lumbar vertebral body motion. 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. 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. 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. 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.