Introduction
>> Jared Howell: This course has been primarily geared to physical therapy, physical therapy assistants, and other health care providers that might interface with patients that are wearing orthoses and/or prostheses. This one specifically targets the realm of spinal orthotics and that is a difficult and challenging area that includes multiple different avenues. I think it is important as we start this lecture to understand and to know that spinal orthoses and spinal orthotics, that profession and field, is huge and complex. We have two hours to cover some of the basics. That is really all we will be able to cover. There is a lot more in-depth study that can be done in any one of these specific topics that we are going to cover. I encourage you, after the course, to do some additional research and I have included some current publications related to the things we will discuss in my reference section. Please feel free to look at those and work to further your knowledge of what spinal orthoses are all about.
We need to do a brief review about spinal orthoses. We will review anatomy and a little bit of spine biomechanics. We will talk about some typical pathologies and what the relevance of the bracing or orthotic side of those technologies look like. I will assume that you have a background in anatomy, basic physiology, and biomechanics. Many of you may have much more experience than even I do in some of these elements. I will assume that and will glaze through some of the aspects related to anatomy, but put things in context related to the orthotic realm so we can have some context and basis for that. Next, we will talk about spinal orthoses in the context of the pathologies that they are treating. In many cases, certain orthoses can treat multiple different pathologies. In the end, we will talk a little bit about current research.
Anatomy Overview
The anatomy of the spine is quite complex, and I think it is important to remember that it is broken down into four basic segments; technically five if you consider the coccygeal vertebrae. You essentially have the cervical spine with seven vertebral bodies, the thoracic spine with 12 vertebral bodies, the lumbar spine with five vertebral bodies, the sacral portion of the spine which has another five fused vertebral bodies, and then you end up with the coccyx at the distal or most inferior end of the spine. It is important to remember this because each one of those segments of the spine reacts differently when you enclose it in an orthosis or when you utilize an orthosis to stabilize it.
Vertebral Anatomy
When we look at the vertebral anatomy, we are looking a few basic things. The vertebral body takes the bulk of the weight that comes through the spine. It essentially absorbs the force that comes through that area. As we look at the posterior portion of the spine, we are starting to look at multiple facets, pedicles, spinal processes, and each of these elements have specific functions. For example, the foramen in the middle of the vertebral body houses something very important to all of us, which is our spinal cord. That is what guarantees we have movement, guarantees that our organs function correctly, and makes sure those signals come off the brain. The way that the spinal cord is designed there are multiple articular processes. The lateral bony prominences are the transverse processes and are used for the articulation of each of the segments of the spine, and they can also act as attachment points for some of the musculature of the spine, both the transverse processes as well as the spinous processes (central bony prominence coming off the vertebral body. It is important as we talk about fractures to point out the laminae and the pedicles on that portion of the vertebral body and the vertebral anatomy. Figure 1 happens to be a thoracic vertebra and you can see in the photo where the facets are available for the attachment of the ribs. That is an important element to think about as we start to look at the thoracic anatomy, because it happens to be perform differently and behave differently in the orthotic side of things than any of the other segments of the spine.
