Stabilization of 2-column thoracolumbar fractures with orthoses: A cadaver model

Paul T. Rubery, Robert D Jr. Brown, Mark Prasarn, John Small, Bryan Conrad, MaryBeth Horodyski, Glenn Rechtine

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

STUDY DESIGN. A gross anatomic and motion analysis study in cadavers. OBJECTIVE. Assess spinal motion in a cadaveric spinal fracture model and investigate the ability of external orthoses to control this motion. SUMMARY OF BACKGROUND DATA. External orthoses are frequently prescribed for patients who have experienced burst fracture of the thoracolumbar spine. Despite the substantial expense involved, there is little data confirming their value. METHODS. A T12 burst fracture model was created in 5 lightly embalmed cadavers by resecting the anterior and middle columns of the T12 vertebra through a thoracolumbar anterior approach to the spine. An electromagnetic motion tracking and analysis system was used to track angular and linear displacement at the fracture during routine patient maneuvers. Several commonly used orthoses, including an extension brace and both an "off-the-shelf" and custom-molded thoracic-lumbar-sacral orthosis (TLSO), were applied to the cadavers and the affect on fracture site motion was assessed. RESULTS. Application of all 3 styles of brace resulted in angular motion of 8 to 12 in flexion-extension, 11 to 20 in axial rotation, and 8 to 10 of lateral bending. Brace application resulted in linear displacement of 29 to 46 mm in the medial-lateral plane, 21 to 23 mm in the axial plane, and 21 to 37 mm in the anterior-posterior plane. During logrolling maneuvers, TLSO style braces diminished angular motion, although residual motion in the range of 5 remained. TLSO style braces had little effect on linear translation. When placed in a seated position in bed, TLSO style braces diminished flexion and extension modestly, but did not influence lateral bending or linear translation. Extension style braces had no effect on fracture motion during any activity tested. CONCLUSION. In a cadaver model of a burst fracture, there is surprising angular and linear motion at the fracture during common hospital activities. TLSO orthoses can decrease angular motion but do not effect translation at the fracture. An extension orthosis had no effect on motion at the spinal fracture site.

Original languageEnglish (US)
JournalSpine
Volume38
Issue number5
DOIs
StatePublished - Mar 1 2013
Externally publishedYes

Fingerprint

Orthotic Devices
Cadaver
Braces
Thorax
Spinal Fractures
Spine
Electromagnetic Phenomena
Articular Range of Motion
Posture

Keywords

  • Burst fracture
  • Cadaver model
  • Spinal orthosis

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Rubery, P. T., Brown, R. D. J., Prasarn, M., Small, J., Conrad, B., Horodyski, M., & Rechtine, G. (2013). Stabilization of 2-column thoracolumbar fractures with orthoses: A cadaver model. Spine, 38(5). https://doi.org/10.1097/BRS.0b013e3182804c73

Stabilization of 2-column thoracolumbar fractures with orthoses : A cadaver model. / Rubery, Paul T.; Brown, Robert D Jr.; Prasarn, Mark; Small, John; Conrad, Bryan; Horodyski, MaryBeth; Rechtine, Glenn.

In: Spine, Vol. 38, No. 5, 01.03.2013.

Research output: Contribution to journalArticle

Rubery, PT, Brown, RDJ, Prasarn, M, Small, J, Conrad, B, Horodyski, M & Rechtine, G 2013, 'Stabilization of 2-column thoracolumbar fractures with orthoses: A cadaver model', Spine, vol. 38, no. 5. https://doi.org/10.1097/BRS.0b013e3182804c73
Rubery, Paul T. ; Brown, Robert D Jr. ; Prasarn, Mark ; Small, John ; Conrad, Bryan ; Horodyski, MaryBeth ; Rechtine, Glenn. / Stabilization of 2-column thoracolumbar fractures with orthoses : A cadaver model. In: Spine. 2013 ; Vol. 38, No. 5.
@article{cc32fb7c21b949639ce6aac7e0d0802e,
title = "Stabilization of 2-column thoracolumbar fractures with orthoses: A cadaver model",
abstract = "STUDY DESIGN. A gross anatomic and motion analysis study in cadavers. OBJECTIVE. Assess spinal motion in a cadaveric spinal fracture model and investigate the ability of external orthoses to control this motion. SUMMARY OF BACKGROUND DATA. External orthoses are frequently prescribed for patients who have experienced burst fracture of the thoracolumbar spine. Despite the substantial expense involved, there is little data confirming their value. METHODS. A T12 burst fracture model was created in 5 lightly embalmed cadavers by resecting the anterior and middle columns of the T12 vertebra through a thoracolumbar anterior approach to the spine. An electromagnetic motion tracking and analysis system was used to track angular and linear displacement at the fracture during routine patient maneuvers. Several commonly used orthoses, including an extension brace and both an {"}off-the-shelf{"} and custom-molded thoracic-lumbar-sacral orthosis (TLSO), were applied to the cadavers and the affect on fracture site motion was assessed. RESULTS. Application of all 3 styles of brace resulted in angular motion of 8 to 12 in flexion-extension, 11 to 20 in axial rotation, and 8 to 10 of lateral bending. Brace application resulted in linear displacement of 29 to 46 mm in the medial-lateral plane, 21 to 23 mm in the axial plane, and 21 to 37 mm in the anterior-posterior plane. During logrolling maneuvers, TLSO style braces diminished angular motion, although residual motion in the range of 5 remained. TLSO style braces had little effect on linear translation. When placed in a seated position in bed, TLSO style braces diminished flexion and extension modestly, but did not influence lateral bending or linear translation. Extension style braces had no effect on fracture motion during any activity tested. CONCLUSION. In a cadaver model of a burst fracture, there is surprising angular and linear motion at the fracture during common hospital activities. TLSO orthoses can decrease angular motion but do not effect translation at the fracture. An extension orthosis had no effect on motion at the spinal fracture site.",
keywords = "Burst fracture, Cadaver model, Spinal orthosis",
author = "Rubery, {Paul T.} and Brown, {Robert D Jr.} and Mark Prasarn and John Small and Bryan Conrad and MaryBeth Horodyski and Glenn Rechtine",
year = "2013",
month = "3",
day = "1",
doi = "10.1097/BRS.0b013e3182804c73",
language = "English (US)",
volume = "38",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Stabilization of 2-column thoracolumbar fractures with orthoses

T2 - A cadaver model

AU - Rubery, Paul T.

AU - Brown, Robert D Jr.

AU - Prasarn, Mark

AU - Small, John

AU - Conrad, Bryan

AU - Horodyski, MaryBeth

AU - Rechtine, Glenn

PY - 2013/3/1

Y1 - 2013/3/1

N2 - STUDY DESIGN. A gross anatomic and motion analysis study in cadavers. OBJECTIVE. Assess spinal motion in a cadaveric spinal fracture model and investigate the ability of external orthoses to control this motion. SUMMARY OF BACKGROUND DATA. External orthoses are frequently prescribed for patients who have experienced burst fracture of the thoracolumbar spine. Despite the substantial expense involved, there is little data confirming their value. METHODS. A T12 burst fracture model was created in 5 lightly embalmed cadavers by resecting the anterior and middle columns of the T12 vertebra through a thoracolumbar anterior approach to the spine. An electromagnetic motion tracking and analysis system was used to track angular and linear displacement at the fracture during routine patient maneuvers. Several commonly used orthoses, including an extension brace and both an "off-the-shelf" and custom-molded thoracic-lumbar-sacral orthosis (TLSO), were applied to the cadavers and the affect on fracture site motion was assessed. RESULTS. Application of all 3 styles of brace resulted in angular motion of 8 to 12 in flexion-extension, 11 to 20 in axial rotation, and 8 to 10 of lateral bending. Brace application resulted in linear displacement of 29 to 46 mm in the medial-lateral plane, 21 to 23 mm in the axial plane, and 21 to 37 mm in the anterior-posterior plane. During logrolling maneuvers, TLSO style braces diminished angular motion, although residual motion in the range of 5 remained. TLSO style braces had little effect on linear translation. When placed in a seated position in bed, TLSO style braces diminished flexion and extension modestly, but did not influence lateral bending or linear translation. Extension style braces had no effect on fracture motion during any activity tested. CONCLUSION. In a cadaver model of a burst fracture, there is surprising angular and linear motion at the fracture during common hospital activities. TLSO orthoses can decrease angular motion but do not effect translation at the fracture. An extension orthosis had no effect on motion at the spinal fracture site.

AB - STUDY DESIGN. A gross anatomic and motion analysis study in cadavers. OBJECTIVE. Assess spinal motion in a cadaveric spinal fracture model and investigate the ability of external orthoses to control this motion. SUMMARY OF BACKGROUND DATA. External orthoses are frequently prescribed for patients who have experienced burst fracture of the thoracolumbar spine. Despite the substantial expense involved, there is little data confirming their value. METHODS. A T12 burst fracture model was created in 5 lightly embalmed cadavers by resecting the anterior and middle columns of the T12 vertebra through a thoracolumbar anterior approach to the spine. An electromagnetic motion tracking and analysis system was used to track angular and linear displacement at the fracture during routine patient maneuvers. Several commonly used orthoses, including an extension brace and both an "off-the-shelf" and custom-molded thoracic-lumbar-sacral orthosis (TLSO), were applied to the cadavers and the affect on fracture site motion was assessed. RESULTS. Application of all 3 styles of brace resulted in angular motion of 8 to 12 in flexion-extension, 11 to 20 in axial rotation, and 8 to 10 of lateral bending. Brace application resulted in linear displacement of 29 to 46 mm in the medial-lateral plane, 21 to 23 mm in the axial plane, and 21 to 37 mm in the anterior-posterior plane. During logrolling maneuvers, TLSO style braces diminished angular motion, although residual motion in the range of 5 remained. TLSO style braces had little effect on linear translation. When placed in a seated position in bed, TLSO style braces diminished flexion and extension modestly, but did not influence lateral bending or linear translation. Extension style braces had no effect on fracture motion during any activity tested. CONCLUSION. In a cadaver model of a burst fracture, there is surprising angular and linear motion at the fracture during common hospital activities. TLSO orthoses can decrease angular motion but do not effect translation at the fracture. An extension orthosis had no effect on motion at the spinal fracture site.

KW - Burst fracture

KW - Cadaver model

KW - Spinal orthosis

UR - http://www.scopus.com/inward/record.url?scp=84875053971&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84875053971&partnerID=8YFLogxK

U2 - 10.1097/BRS.0b013e3182804c73

DO - 10.1097/BRS.0b013e3182804c73

M3 - Article

C2 - 23211532

AN - SCOPUS:84875053971

VL - 38

JO - Spine

JF - Spine

SN - 0362-2436

IS - 5

ER -