What motions do TLSOs attempt to restrict

The thoracic region is the most stable and least mobile portion of the spinal column. The thorax provides inherent stability with its connecting ribs and sternum. The coronal orientation of the thoracic facet joints is such that rotation is the major motion requiring restriction. This motion is difficult to control and requires a custom-molded orthosis if maximal motion control is required. The thoracolumbar junction is a transition region between the stable upper and middle thoracic regions and the mobile lumbar region. Facet joint orientation transitions from a coronal to a sagittal orientation in this region. The lumbar region is more mobile than the thoracic region with flexion-extension motion predominating due to the sagittal orientation of the lumbar facet joints. Experimental studies have shown that full-contact TLSOs can effectively restrict motion between T8 and L4. If motion control is required above T8, a cervical extension should be added to the TLSO. Experimental studies have also shown that a TLSO paradoxically increases motion at the L4-L5 and L5-S1 levels. As a result, a thigh cuff must be added to the TLSO if motion control is desired at the L4-L5 and L5-S1 levels. Because limited contact braces function by applying forces via sternal and pubic pads, these orthoses provide only mild restriction of sagittal plane motion (flexion-extension) and do not effectively limit coronal or transverse plane motion.

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