spine case summary with result
Ralph Nobbe
Description
Collection
Title:
spine case summary with result
Creator:
Ralph Nobbe
Date:
7/26/2004
Text:
Original post, then suggestions separated by (+) then our solution. Thanks
to all for input.
Have been referred a somewhat challenging case. Looking for ideas.
85yo frail, moderately obese, hyperkyphotic, female, fell 4 months ago and
ended up with T,5, 7 and T12 compression fx along with a coccygeal fx. (Fell
backwards on a stairwell and ended up landing on butt and head and shoulders
got wedged against? under? hand rail on landing. EMT's had to extract her)
Presented to ER two nights ago with intractable pain. Had a decompression
laminectomy yesterday at T7 level. Fractures are stable with subtle
compression noted. Any suggestions to to stabilize T5 against forward
flexion? Seems to primary pain center following the T7
decompression.Considered using a long dorsolumbar type corset but extensive
scarring following radical mastectomy 15+ years ago may create a tolerance
issue. T12 being managed well with long corset at this time.
++++++++++++++
try bivalve tlso with sternal bar but flex foam
+++++++++++++
The only way you are going to be able to control flexion at T5 is with TLSO
with cervical extension or possibly a Cervical Thoracic Orthosis of some
kind. T5 is at the superior edge of a TLSO, so the edge becomes a fulcrum
instead of motion limiter, especially with a compresion fracture.
Tough one, the first thing I might try is the long Dorsolumbar corset you
mentioned with a sheepskin pad protecting the breast area from the top of
the corset front with sheepskin axillary pads. Second try would be a
modified CASH or alike, with a custom molded chest plate with sheepskin or
custom silicone padding. If T5 is still not controlled, possibly adding a
tall foam collar to stop the head from rolling anteriorly and inferiorly.
At 85 years old, the underlying goal should try to keep this person up and
as active as possible during the recovery.
++++++
Think about the D.H.O. by Seattle, you can add appropriate padding easily
and adjust anterior sternal support. model 112DHO S,M,L,
++++++
Have you considered using a Flexfoam TLSO with an anterior or lateral
opening? The high profile design would adequately control forward flexion at
T-5 while distributing the necessary pressure across her sternum. You also
gain intra-abdominal pressure that the corset provides. The lateral or
anterior opening would aid in independent application of the orthosis.
++++++
a Minerva style cervical orthosis will address this level but elderly
folks tend not to accept such a high level of bracing. Seattle Systems sells
them along with other designs. Another options would be a semi rigid collar
with a thoracic extension (Aspen or Philadelphia).
+++++
Our solution - we continued using the long lumbar corset for T12 - she was
acclimated and reasonably comfortable. We ended up using the Miami J with
the thoracic extension over the top of the corset. The combination allows
both devices to work in concert, or be used seperately, is light weight and
the flexibility inherent in the floating posterior component works without
displacing the cervical component. She does require donning assistance for
the CTO but is able to manage with logrolling. Corset is applied supine then
CTO over top.
Extensions placing any pressure in sternal region were outright rejected,
(tried ACE brace to no avail)
Did all this last Thurs pm, no 911 calls over weekend and in Monday
follow-up I didn't get thrown out of the room by patient.
Ralph W. Nobbe, CPO
President
Nobbe Orthopedics, Inc.
<Email Address Redacted>
to all for input.
Have been referred a somewhat challenging case. Looking for ideas.
85yo frail, moderately obese, hyperkyphotic, female, fell 4 months ago and
ended up with T,5, 7 and T12 compression fx along with a coccygeal fx. (Fell
backwards on a stairwell and ended up landing on butt and head and shoulders
got wedged against? under? hand rail on landing. EMT's had to extract her)
Presented to ER two nights ago with intractable pain. Had a decompression
laminectomy yesterday at T7 level. Fractures are stable with subtle
compression noted. Any suggestions to to stabilize T5 against forward
flexion? Seems to primary pain center following the T7
decompression.Considered using a long dorsolumbar type corset but extensive
scarring following radical mastectomy 15+ years ago may create a tolerance
issue. T12 being managed well with long corset at this time.
++++++++++++++
try bivalve tlso with sternal bar but flex foam
+++++++++++++
The only way you are going to be able to control flexion at T5 is with TLSO
with cervical extension or possibly a Cervical Thoracic Orthosis of some
kind. T5 is at the superior edge of a TLSO, so the edge becomes a fulcrum
instead of motion limiter, especially with a compresion fracture.
Tough one, the first thing I might try is the long Dorsolumbar corset you
mentioned with a sheepskin pad protecting the breast area from the top of
the corset front with sheepskin axillary pads. Second try would be a
modified CASH or alike, with a custom molded chest plate with sheepskin or
custom silicone padding. If T5 is still not controlled, possibly adding a
tall foam collar to stop the head from rolling anteriorly and inferiorly.
At 85 years old, the underlying goal should try to keep this person up and
as active as possible during the recovery.
++++++
Think about the D.H.O. by Seattle, you can add appropriate padding easily
and adjust anterior sternal support. model 112DHO S,M,L,
++++++
Have you considered using a Flexfoam TLSO with an anterior or lateral
opening? The high profile design would adequately control forward flexion at
T-5 while distributing the necessary pressure across her sternum. You also
gain intra-abdominal pressure that the corset provides. The lateral or
anterior opening would aid in independent application of the orthosis.
++++++
a Minerva style cervical orthosis will address this level but elderly
folks tend not to accept such a high level of bracing. Seattle Systems sells
them along with other designs. Another options would be a semi rigid collar
with a thoracic extension (Aspen or Philadelphia).
+++++
Our solution - we continued using the long lumbar corset for T12 - she was
acclimated and reasonably comfortable. We ended up using the Miami J with
the thoracic extension over the top of the corset. The combination allows
both devices to work in concert, or be used seperately, is light weight and
the flexibility inherent in the floating posterior component works without
displacing the cervical component. She does require donning assistance for
the CTO but is able to manage with logrolling. Corset is applied supine then
CTO over top.
Extensions placing any pressure in sternal region were outright rejected,
(tried ACE brace to no avail)
Did all this last Thurs pm, no 911 calls over weekend and in Monday
follow-up I didn't get thrown out of the room by patient.
Ralph W. Nobbe, CPO
President
Nobbe Orthopedics, Inc.
<Email Address Redacted>
Citation
Ralph Nobbe, “spine case summary with result,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 1, 2024, https://library.drfop.org/items/show/223442.
