>Dear Colleagues,
>Has anyone read recent research or heard any speeches regarding the
>”necessity
>or desirability” of Post-op spinal support given the advances in spinal
>surgery? Is anyone experiencing changes in the frequency of prescriptions
>for spinal supports and/or a downgrading from a L0400 type to a Corset
>style?
>Let me know
>Pat
>
Overt the past decade, the evolution in spinal instrumentation systems
that claim to not only be segmental but also 3-column fixation has led to
some corporate slogans of “bracem from the inside” and, despite a void of
scientific support for the downgrading or elimination of post-operative
orthoses, has led to a trend to “believe” in the strength of the
procedure. Some of us (including my research colleagues) believe that Moe
was right when he took the first spinal instrumentation that was breaking
with frequency, and used a post operative cast to sucessfully prevent
hardware failure, thus “bracing the brace”. Despite some suggestions to
continue using WELL FITTED CUSTOM TLSO’s after the newer procedures, the
orthoses were abandonned. One of the instrumentation companies in 1-97
settled a class action case for hardware breakage out of court for 110
Million and despite the size of this lump sum, it only resulted in a few
thousand dollars per plaintiff (alot of breakage???) The same company
sold out to another biomedical company in 4-98 and since then, I have
seen the use of post-operative TLSO’s increase significantly. Maybe some
of the docs have figured something out, but the role of post-op TLSO’s
still needs to be investigated scientifically. THIS WOULD BE A FAIRLY
GRANDIOSE STUDY AND COST ABOUT 700K but would yield info on how much
orthosis for a given injury and procedure. Most of this was for
degenerative disorders. Docs always have believed that a TLSO is
essential after a fusion for fracture and school is not out on the TLSO
after deformity procedures. For deformity, it is thought that maybe the
TLSO is not necessary to prevent hardware failure, but it may prevent
post-op decompensation and enhance the concept of “spontaneous
correction” of the unfused lumbar segments. I believe that in the near
future the TLSO usage will continue to rise and it is UP TO US ORTHOTISTS
TO BE SURE WE USE WELL FITTED ORTHOSES NO MATTER WHAT IT TAKES AND TO
DOCUMENT AN UNREPORTED PHENOMENA OF THE REDUCTION OF POST-OP PAIN as a
mechanism of action of the orthosis.
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Thomas M. Gavin, C.O.
President, Director of Clinical Services
BioConcepts, inc. Orthotic-Prosthetic Centers
100 Tower Drive, Suite 101
Burr Ridge, Illinois 60521
Voice: (630) 986-0007
Fax: (630) 986-0151
WEB PAGE http://www.orthotic.com
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