Wednesday, November 30, 2022

Trunk leaning

Rick Stapleton

Hello list-serve,

I have a gentleman who was prescribed a TLSO for kyphosis and trunk leaning. When I evaluated him he really has very little kyphosis but has anterior trunk lean from bilateral hip flexion contractures of 15 degrees. His physical traits are: 67″, 172 lbs, 72 y/o, s/p R THR 1999, spinal stenosis with fusion T11-S1, L THR 2008. In my opinion none of the “dorsolumbar” orthoses or any TLSO that I know of will help with the anterior trunk lean. The patient is a radiologist who is close to retiring but currently sits for 10-12 hours 4 days a week in his practice. He is currently going through PT to work on his hips but the referring physician is very adamant about fitting him with a TLSO. I don’t see how anything that doesn’t cross the hip can exert enough leverage to correct his anterior lean while supporting a fused spine. Am I missing something? Is there a simple or straight forward orthosis to help this gentleman? Is there such a thing as a dynamic TLSHO that someone would actually wear?

My advice to the patient is to work very hard with PT and develop some sort of exercise routine to counteract the long hours of sitting. He did comment that when he does retire (very soon) he should have more time to devote to “straightening up”. I also told him I would see what any of my colleagues would recommend for his particular pathology.

Thanks in advance for your help,

Rick, CPO

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