Steps involved in the fabrication of Spinal Orthoses

1
How to Fabricate a Lumbosacral Orthosis (LSO)
2
Materials Used to Fabricate an LSO

• Plaster splints Used to make the plaster shell
  of mold
• Plaster of Paris Used to make the mold
• Plastics
• Thermo plastics can be heated and molded over
  and over again.
• acrylic, polyethylene, polypropylene
• Fabric use fabric (typically Velcro) straps
• Metal
• Copper or stainless steel rivets

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Overview of Fabrication Process

• Evaluation/Prescription
• Taking measurements (casting)
• Fabrication
• Fitting
• Modifications
• Re-evaluation/follow-ups

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4
Evaluation/Prescription

• Ideally, a multi-disciplinary team of specialists
  examine patient
• Prescription based on evaluation of patients
  needs
• The evaluation generally involves several x-rays

X-ray of a patient with scoliosis back view
5
Taking measurements

• Measure lengths and circumferences of body
  segments
• Note locations of bony landmarks xiphoid
  process, ribs, the ASIS (Anterior Superior Iliac
  spine), waistline, and symphysis pubis
• mark potential complications such as weight
  problems

6
Fabrication of an LSO

• OPTIONS
• Pre-Fabricated device first option
• Custom-fit is second option
• Custom-made is final option
• If custom device is required, the orthotist uses
  the measurements and impression to create a
  positive mould of the affected body segment
• The device is then adjusted by the orthotist

7
Fabrication Specifics for an LSO

• Place two layers of stockinet over patients
  torso
• Position patients body in a way that would
  correct the problem, often hyperextension
  position
• Apply plaster splints from bottom to top
• Tuck plaster splints under the patient mark
  landmarks with indelible pencil
• Strap the mold and roll patient
• Apply splints vertically to back, mark the
  fractures and the top and the bottom of the mold
• While removing the cast, take the first layer of
  the stockinet
• Once cast is removed, seal it together with extra
  splints

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Fabrication Specifics (contd)

• At the lab, seal bottom of cast
• Place in tub, wash the inner wall of the cast
  with a solution of detergent, add plaster until
  cast is full
• Place a bent metal pipe in center of cast
• Once plaster dries, remove the splint shell
• Place the pipe of the mold horizontally into a
  vacuum support
• Accentuate the grooves, add additional plaster to
  smoothen the surface
• Heat plastic until soft, place over mold
• Turn on vacuum to conform plastic to mold more
  precisely
• When plastic hardens, remove from mold
• Cut excess plastic from mold
• Smooth edges with various buffer heads
• Add Velcro straps using copper rivets

9
Fitting an LSO

• Patient tries on LSO to see how it fits
• Notifies orthotist of any discomfort
• The orthotist evaluates if the pressure areas are
  within tolerable limits for the patient
• Verify whether or not forces are being applied at
  the correct points

10
Modifications of an LSO

• An orthosis usually requires modification
• Minor changes may include
• Addition of padding
• Localized thermal molding
• Removal of material by grinding
• Major changes may include
• substitution of different parts
• the re-fabrication of any part of the device that
  doesnt perform satisfactorily
• Completely scrapping the original device and
  starting from the beginning

11
Re-evaluations/Follow-ups

• Schedule a re-evaluation and follow-ups at
  regular intervals
• Wear-and-tear could change the function of the
  device
• Patient needs may change over time and due to a
  change in their lifestyle, weight, body
  proportions

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