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Video Fluoroscopic Analysis of the Effects of Three Commonly-Prescribed Off-the-Shelf Orthoses on Vertebral Motion

Utter, Andrew, MD*; Anderson, Meredith L., MD; Cunniff, Joseph G., DO; Kaufman, Kenton R., PhD, PE§; Jelsing, Elena J., MD; Patrick, Todd A., MD, PhD; Magnuson, Dixon J., MS, RT(R); Maus, Timothy P., MD; Yaszemski, Michael J., MD, PhD**; Basford, Jeffery R., MD, PhD††

doi: 10.1097/BRS.0b013e3181c62fa1
Clinical Case Series

Study Design. Fluoroscopic assessment of the effects of commercially available spinal orthotics on lumbar vertebral motion as subjects performed flexion and extension maneuvers.

Objective. To quantitate the effects of 3 commonly available, off-the-shelf, soft, and semirigid spinal orthoses on lumbar spinal motion.

Summary of Background Data. 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.

Methods. 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 (LSO), a semirigid LSO, or a semirigid thoracolumbrosacral orthosis (TLSO) 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.

Results. Each of the braces produced a statistically significant reduction in overall lumbar motion during the flexion maneuver (P = 0.007) but none had a detectable effect during extension. Relative effectiveness varied by vertebral level. At the L3–L4 level, only the TLSO had a statistically significant effect on intervertebral flexion movement (32%, P = 0.003). 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 TLSO to about 15% to 20% for the 2 LSOs. No effects were noted for any of the orthoses at the L5–S1 level.

Conclusion. Commercially available soft and semirigid orthotics can have significant effects on lumbar vertebral body motion at the L3–L4 and L4–L5 levels.

Three off-the-shelf spinal orthotics were assessed fluoroscopically. All reduced lumbar motion during flexion; none significantly reduced extension. Effectiveness varied by level. At L3–L4 only the TLSO significantly reduced intervertebral flexion; at L4–L5 all were effective in reducing flexion-associated intervertebral motion. No orthotic effects were noted at the L5–S1 level.

From the *Center for Spine Health, Cleveland Clinic Foundation, Cleveland, OH; †Department of Radiology, Mayo Clinic, Rochester, MN; ‡The Smart Clinic, Sandy, UT; §Department of Orthopedic Surgery, Orthopedics Biomechanics Laboratory, Mayo Clinic, Rochester, MN; ¶Mayo Clinic, Rochester, MN; ∥Trinity Mother Frances Health System, Tyler, TX; and Departments of **Orthopedic Surgery and ††Physical Medicine and Rehabiliation, Mayo Clinic, Rochester, MN.

Acknowledgment date: February 23, 2009. Revision date: August 10, 2009. Acceptance date: August 19, 2009.

The drug(s)/drug(s) that is/are the subject of this manuscript is/are exempt from FDA or corresponding national regulations because the FDA does not regulate these Orthoses.

Funds were received for research from Mayo Clinic Department of Physical Medicine and Rehabilitation. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supported by Department of Physical Medicine and Rehabilitation of the Mayo Clinic, Rochester, MN.

Address correspondence and reprint requests to Jeffery R. Basford, MD, PhD, Department of Physical Medicine and Rehabiliation, Mayo Clinic, Rochester, MN 55902; E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.