Re: TLSO for osteoporosis
Paula Pivko
Description
Collection
Title:
Re: TLSO for osteoporosis
Creator:
Paula Pivko
Date:
7/17/2019
Text:
Hello, all and thank you for your responses about my patient. She's had issues come up and we're only now finishing the brace. We have decided on a soft, flexible TLSO with a cut out where needed. It will have an adjustable pectoral plate so it straightens her as much as possible without putting pressure on her sternum. I've done one fitting that went well but more trimming is needed. I am going to post responses. Many mentioned the Medi Spinomed brace, Spinal Tech, the Aspen line, and Spinecore. Here are the others.
I wish to offer you something to attempt as I tried multiple times in my 50+ years in orthotics to help such patients out. To begin with, I truly believe that there is no one procedure that can do it all. I traditionally managed this type of patient in the following manner. Either in bed or on my exam table I would have the patient attempt to get into a comfortable position most likely she will end up on her side. If she can find comfort then the best option would be to try and capture the position of her spine. Preparing her in advance with a stockinette shirt, I would lay splints of plaster from the SI to the superior scapula area. Extend the splints far enough laterally in order to make it possible to form a positive mold that can be filled with plaster after removal. My goal is to try and fabricate a semi-flexible posterior panel that would simulate where an old fashioned Taylor Orthosis would lie on the spine. Unfortunately, you would have to rely on using padded shoulder straps and a suitable pelvic strap. As I am sure you know correction is not the goal accommodation that can offer some relief of pain is. Hope this helps with your decision process.
I am wondering whether you found a solution. I had a kyphotic lady in her 80's and fit her with a custom flex foam TLSO from Spinal Tech. I took a cast impression and measurements because she was so deformed and I didn't have a laser scanner at the time. She loved it and was very comfortable. If you're not familiar with the Flex Foam, check out their website <URL Redacted>
Have you tried a CASH brace?
In my experience, only a modified Velcro corset will be acceptable to the patient.
I have a very similar patient, colostmy included plus scoliosis. She is very compliant with whatever we try which really helps. The best success I have had is a CASH brace which had some minor modifications for the colostomy and then a custom posterior pad which I molded with low temp thermoplastic over a slabcast of her spine since it is very prominent. I molded thermofoam over the slabcast over the boney areas and then the low-temp plastic over that. I attach the back pad with loops so it can slide into the correct position.
The most difficult thing for her is donning since she is independent. I had to extend the strap so that she could just step into the device rather than try and feed the strap through d-rings.
She reports that she doesn't necessarily wear it all the time but she does feel a lot of relief from the spinal extension force. Unfortunately this is a difficult treatment at the best of times!
I’ve had good luck with the Spinal Tech Flex foam system for my geriatric patients. You can make a custom outer frame that provides a good amount structure while giving you good options to make cutouts as needed. You also have the option to make it with no rigid frame at all which I’ve done with some of my small, frail patients. Good luck, these are always difficult cases.
It is very difficult if not impossible to straighten up kyphosis without
extending onto the thighs, which most people will not tolerate. The lady
holding herself up with a stick or walking frame or/and having a weighted
back pack I am afraid may be the only way to extend her a little.
How about a custom Fusion tlso from Orthomerica
Again I thank you all for your help, as always.
Paula Martinek, LPO
This communication may contain information that is legally protected from unauthorized disclosure. If you are not the intended recipient, please note that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this message in error, you should notify the sender immediately by telephone or by return e-mail and delete the message. Thank you.
________________________________
I wish to offer you something to attempt as I tried multiple times in my 50+ years in orthotics to help such patients out. To begin with, I truly believe that there is no one procedure that can do it all. I traditionally managed this type of patient in the following manner. Either in bed or on my exam table I would have the patient attempt to get into a comfortable position most likely she will end up on her side. If she can find comfort then the best option would be to try and capture the position of her spine. Preparing her in advance with a stockinette shirt, I would lay splints of plaster from the SI to the superior scapula area. Extend the splints far enough laterally in order to make it possible to form a positive mold that can be filled with plaster after removal. My goal is to try and fabricate a semi-flexible posterior panel that would simulate where an old fashioned Taylor Orthosis would lie on the spine. Unfortunately, you would have to rely on using padded shoulder straps and a suitable pelvic strap. As I am sure you know correction is not the goal accommodation that can offer some relief of pain is. Hope this helps with your decision process.
I am wondering whether you found a solution. I had a kyphotic lady in her 80's and fit her with a custom flex foam TLSO from Spinal Tech. I took a cast impression and measurements because she was so deformed and I didn't have a laser scanner at the time. She loved it and was very comfortable. If you're not familiar with the Flex Foam, check out their website <URL Redacted>
Have you tried a CASH brace?
In my experience, only a modified Velcro corset will be acceptable to the patient.
I have a very similar patient, colostmy included plus scoliosis. She is very compliant with whatever we try which really helps. The best success I have had is a CASH brace which had some minor modifications for the colostomy and then a custom posterior pad which I molded with low temp thermoplastic over a slabcast of her spine since it is very prominent. I molded thermofoam over the slabcast over the boney areas and then the low-temp plastic over that. I attach the back pad with loops so it can slide into the correct position.
The most difficult thing for her is donning since she is independent. I had to extend the strap so that she could just step into the device rather than try and feed the strap through d-rings.
She reports that she doesn't necessarily wear it all the time but she does feel a lot of relief from the spinal extension force. Unfortunately this is a difficult treatment at the best of times!
I’ve had good luck with the Spinal Tech Flex foam system for my geriatric patients. You can make a custom outer frame that provides a good amount structure while giving you good options to make cutouts as needed. You also have the option to make it with no rigid frame at all which I’ve done with some of my small, frail patients. Good luck, these are always difficult cases.
It is very difficult if not impossible to straighten up kyphosis without
extending onto the thighs, which most people will not tolerate. The lady
holding herself up with a stick or walking frame or/and having a weighted
back pack I am afraid may be the only way to extend her a little.
How about a custom Fusion tlso from Orthomerica
Again I thank you all for your help, as always.
Paula Martinek, LPO
This communication may contain information that is legally protected from unauthorized disclosure. If you are not the intended recipient, please note that any dissemination, distribution, or copying of this communication is strictly prohibited. If you have received this message in error, you should notify the sender immediately by telephone or by return e-mail and delete the message. Thank you.
________________________________
Citation
Paula Pivko, “Re: TLSO for osteoporosis,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 2, 2024, https://library.drfop.org/items/show/209561.
