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. 2019 Oct 20;4(1):74-80.
doi: 10.22603/ssrr.2019-0018. eCollection 2020.

What Type of Orthosis is Optimal for Conservative Treatment of Lumbar Spondylolysis?: A Biomechanical Analysis

Yosuke Fujimoto  1 , Toshinori Sakai  2 , Koichi Sairyo  2
Affiliations

What Type of Orthosis is Optimal for Conservative Treatment of Lumbar Spondylolysis?: A Biomechanical Analysis

Yosuke Fujimoto et al. Spine Surg Relat Res. .

Abstract

Introduction: To analyze the extent to which various types of orthoses can restrict motion of the lumbar spine and provide basic evidence regarding the optimal orthosis for conservative treatment of lumbar spondylolysis (LS), particularly. Although several orthoses have been developed and applied for LS with better outcomes for bony healing, basic data regarding which is optimal are still lacking.

Methods: Ten healthy voluntary participants were included in this study. Lumbar spine range of motion (ROM) was analyzed using a three-dimensional motion capture system (NEXUS 2.2, Vicon Motion Systems Ltd., UK) under five conditions wearing no orthosis (NB) and four types of lumbar-sacral orthoses (LSO): custom-made hard LSO (HO), soft LSO supported by four aluminum stays and a custom-molded back cast-panel named "Return to Sports" braces (RS), custom-made soft LSO known as Damen type elasticity corset (DC), and off-the-shelf soft LSO.

Results: HO showed the highest restriction of motion in all directions than the others. Especially, ROM of rotation and side bending were reduced to 58.3% and 63.6% compared with NB, respectively. The other three LSOs showed significantly higher restriction in extension, rotation, and side bending than NB. In flexion and side bending, DC showed significantly higher restriction than NB.

Conclusions: HO showed high restriction in all directions. RS showed higher restriction in extension than NB and less restriction in flexion and side bending than other custom-made LSOs. DC was the only soft LSO showing higher restriction than NB in flexion.

Keywords: conservative treatment; lumbar spondylolysis; orthosis; stress fracture.

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Conflict of interest statement

Conflicts of Interest: Y. Fujimoto is the representative director of Fujimoto Prosthesis and Orthosis Supply Co. Ltd. All other authors confirm that there are no conflicts of interest with people or organizations that could bias the nature of this report.

Figures

Figure 1.
Figure 1.
Four types of lumbar sacral orthoses (LSO) used in this study: (a) custom-made hard LSO (HO), (b) soft LSO supported by four aluminum stays and a custom-molded back panel named “Return to Sports” braces (RS) (Light-brace RS; ARCARE Co. Ltd., Tokyo, Japan), (c) custom-made soft LSO known as Damen type elasticity corset (DC), (d) off-the-shelf soft LSO (SO) (Max Belt R2; Nippon Sigmax Co. Ltd., Tokyo, Japan).
Figure 2.
Figure 2.
Range of motion (ROM) values of the spine with four types of LSO and NB in flexion. Data are expressed as percentages relative to NB. HO (P=0.0002) and DC (P=0.0038) showed significantly higher restriction than NB in flexion. Data are also expressed as median (interquartile range) under each bar.
Figure 3.
Figure 3.
ROM values of the spine with four types of LSO and NB in extension. Data are expressed as percentages relative to NB. HO (P<0.0001), RS (P<0.0001), DC (P=0.0133), and SO (P=0.0218) showed significantly higher restriction than NB in extension. Data are expressed as median (interquartile range) under each bar.
Figure 4.
Figure 4.
ROM values of the spine with four types of LSO and NB in rotation. Data are expressed as percentages relative to NB. HO showed significantly higher restriction than NB (P<0.0001) and other three types of LSO in rotation: RS (P=0.0003); DC (P<0.0001); and SO (P<0.0001). RS (P<0.0001), DC (P<0.0001) and SO (P<0.0001) showed significantly higher restriction than NB in rotation. Data are expressed as median (interquartile range) under each bar.
Figure 5.
Figure 5.
ROM values of the spine with four types of LSO and NB in side bending. Data are expressed as percentages relative to NB. HO showed significantly higher restriction than NB (P<0.0001), and the other three types of LSO in side bending: RS (P<0.0000), DC (P<0.0001), and SO (P<0.0001). RS showed significantly lower restriction than DC (P<0.0024) in side bending. RS (P<0.0001), DC (P<0.0001), and SO (P<0.0001) showed significantly higher restriction than NB in side bending. Data are expressed as median (interquartile range) under each bar.
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