Saturday, June 22, 2024

Are you in need of a cervical collar and lumbar belts?

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The spinal orthosis is an external device used to immobilise the spine and to modify structural and functional characteristics of the musculoskeletal system. The spine is a complex structure that is the main support for our body to stand erect. There are different sizes and types of spinal orthosis according to the needs of the patient, determining the type of movement to be restricted (Sagittal plane, coronal plane, transverse plane, combinations of direction). The main aim of orthosis is to provide support stabilisation and maintain alignment of the spine, reduce pain, post-operative assist, reducing load on the spine and restriction of motion.

Cervical collars are commonly advised to the patients by their doctor to immobilise the neck in view of stability and pain relief. The cervical collar helps in maintaining the neck position in normal anatomical position, which is lordosis.

There are two types of cervical collar, based on the material used.
Soft cervical collar – It is made of foam and coated with cotton wool. It provides no structural support to the spine, however it gives psychological reassurance and partial support to the spine with movement limitation up to 8–20 percent in all neck movements. Mainly suggested in muscular sprains and trivial trauma.

Hard cervical collar – It is made of hard foam combined with plastic which is rigid and semirigid with main purpose of support in traumatic spinal injuries. With movement restriction of 35 – 90 percent in all neck movements. Few collars have provision for tracheostomy and head chin occiput adjustment to get the best fitting for optimum immobilisation. Indicated in high velocity cervical injuries including unconscious patients, unstable spine, post-operative care and cervical strain.

Types of hard cervical collar – Philadelphia collar, Miami J collar, VISTA collar, Aspen.
Cervical collars are fitted into a rigid chest brace which keeps the head and chest in a constrained position. Eg- SOMI brace, Minerva.

Cervical braces are worn for a limited duration for approximately 1 week to 10 days for pain relief due to muscle sprain alone. In traumatic unstable fractures treated conservatively, for immobilisation and to maintain stability, they are kept for 6 – 8 weeks.

However, the cervical collars are not to be worn for long duration as it causes deconditioning of neck muscles, psychological dependence and neck muscle contracture and atrophy.

Though cervical collars are effective for short duration for pain relief, they are not an alternative for other treatment modalities. However, it can be an effective when advised correctly as a treatment adjunct.

Lumbosacral orthosis:
The name itself indicates the part of spine where it is used. Lumbosacral orthosis is used for pain relief, postural support, reduce or maintain lumbar curvature (lordosis), post-surgical state, traumatic instability of spine, spinal fractures, postural pain and degenerative conditions.

Lumbar support prevents back pain by properly aligning muscles and spine, thereby relieving strain on spine. Like cervical collar, lumbar belts should not be worn for more than a week as the lower back muscles get accustomed to it and will become dependent as the muscles get deconditioned and weak.

(The writer is Dr. Venkata Ramakrishna T, Consultant Spine Surgeon, Yashoda Hospitals, Hyderabad.)

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