Jewett vs. TLSO Replies

Posted By: Mark Seibel on September 27, 2010

List,
Thank you all for the numerous replies. I'll restate the question and
list the responses anonymously.

Hello List,
I was hoping some of you spinal experts can shed some light on what
criteria are used to decide when a Jewett brace is appropriate as
opposed to a custom TLSO for spinal fractures. We are located in a
large rural hospital and Neurosurgery and Orthopedics don't agree. Is
there a consensus out there? Thanks for your input.
Mark Seibel CPO

+Please understand the biomechanics involved. The Jewett is a
Hyperextension device type specific for STABLE Lumbar Anterior
Compression fractures. Should you have an unstable Lumbar fx then an LSO
or TLSO (depending upon the level of involvement) would be indicated.
Hope it helps!


+We use the injury site as the determining variable. For intense if the
injury is in the anterior column a Jewett would be ok in most instances
as they are more often than not trying to prevent flexion. Just like
years ago when posterior column injuries were treated with Williams
flexion orthoses (and still may be in some places).


+I've always believed that Jewetts are for 0-50% compression, stable,
anterior vertebrae fx's from about T-11 to L-2. Anything higher,
lower,
multiple levels, or any question of stability go to full TLSO. Body
shape is also a factor when choosing the design.

+Historically it depends on the number of levels of involvement along
with the type of fracture.
Single non-burst - Jewett
Multiple simple - Jewett
Single burst - TLSO
Multiple other and burst - TLSO
Hope this helps.
Could explain more but thumbs can't type that long.

+Without knowing the specifics, the short answer is as follows...
Jewitt- single level compression fracture.
TLSO- multilevel fx., Burst fx., etc.

+We have the same problem and I work at a University hospital!
Jewett's
getting prescribed for T8 fractures, so the top edge acts as a
fulcrum.
It seems like it is worse when we get a new batch of resident's in. I
was taught that a Jewett is for T11, T12, L1 compression fractures and
that is about it. It would be interesting to do a Google search and
see
if there are any articles out there to back up your position.
Please post your answers.

+Hi,
This would be my personal maybe subjective criteria for choosing Jewitt
versus TLSO
A Jewitt is appropriate for a single column, stable anterior
compression fracture at the thoracolumbar spine, meaning T11-T12-L1-L2,
is not appropriate for any type of burst fracture, osteoporotic spine,
mid to upper thoracic fractures. It does not control any rotation and
does not fit properly anyone who is shorter and heavier as the wider
sizes do not go short enough, which usually ends up in a poor fit.
The benefits of TLSO would be total contact, more intimate fit,
unweights, rotational control.
Hope this is of some benefit.


+Very good question Mark,
Is there an outcomes study? Is anyone interested? Simple compression
fxs should do well with a Jewett up to t-12. Burst or any unstable fxs
should have a TLSO.


+It really all depends on each situation. I look for what I need to
control.
1. Hydrostatic lift... TLSO
2. Hyperextension and Lateral Control... Jewttt
3. Pelvic tilt TLSO
4.Correct Lumbar or Thoracic curve ( lordoses and Kyphoses) Mild not
scoli
or Sherman's TLSO
I hope this helps. Sorry for the spelling I was in a rush,


+I have seen in practice this criteria, two column fx needs max
orthosis
support if not a surgical candidate, single column fx of 25% or less
compression in the T11-L1 region you can use a Jewett. I have
witnessed
solid pain control with fx's a few levels proximal to T11, IF the right
body
shape for max leverage of a jewett and the patient is compliant. Pt's
have
a lot of control over the outcome with a spinal, I try to fit the most
compliant brace so the Pt actually uses it instead of the "correct" one
in
the closet. Not terribly scientific or objective, just 30 years of
observation.

+Jewett is for anterior compression fx T12-L2
Custom TLSO/body jacket is for a non-stable fracture T7-L2
Hope this helps,


+It is dependent on compliance, patient health (time to heal, eg
diabetes, smoking, etc), scoliosis, kyphosis, as well as the percentage
of the compression Fx. A burst is its own creature. Jewett is
contra-indicated with osteoporosis.
I would have the doctors come together, and figure out a percentage of
compression that both are agreeable with, and if a burst automatically
means a custom. If 20 percent is no brace, and 40 percent is surgery,
then the figure should be somewhere in the middle.


+really it depends on the Fracture. most of the time we use a jewett
for compression fractures the are fairly stable. If you are dealing with
an unstable fracture, the TLSO is the way to go.And sometimes you can
get by with a cash brace for stable compression fractures.

+Stable compression fracture, use the Jewet Any unstable or burst
fracture, use the TLSO
I would not use a Jewet for anything other than a stable comp fracture.
That is all it is designed for.


+Stable fracture (compression fracture) use Jewett. Unstable fracture
(burst
fracture) use custom TLSO. Also use custom TLSO if abnormal anatomy
(severe
kyphosis). Just some thoughts.


+Jewett is used in stable spinal fractures with no damage to articular
facets. Usually used as conservative treatment.
Custommade braces are usually used as adjuvant therapy for fixation of
the operated spine.
Hope it helps

+We have a middle-of-the-road option on in this situation. We typically
use a prefabricated bivalve or 4-panel TLSO and add a sternal extension
or axilla/shoulder strap kit. We keep a wide inventory of prefabricated
sizes and shapes to fit well. Contouring the sternal bar and posterior
panel angles allow us to control the thoracic extension force and
posture. The bivalve lumbar section gets good purchase, restrict motions
and reduces rotation. You need an option other than sternal bar if
patient has a pacemaker or history of mastectomy.
This approach allows for quick service and good functional outcomes
while keeping cost lower. Hope this helps.


+Our docs usually use jewetts for compression type fractures and the
custom tlso for the more unstable burst type fractures

+When you need only to thoracic flexion (sagittal plane), ie thoracic
compression fx. and the fracture is not unstable, the Jewitt is very
effective. Of course it also inhibits some motion in other planes, but
not effectively enough to make the claim. My humble opinion and I have
fit many of both in my 29 years.

+A Jewett is more appropriate for T10 to L2 anterior compression
fractures. Anything outside of this specific diagnosis may be better
treated with TLSO.

+I have ran into this myself. I went to school @ UW and the position
there was single level stable compression fx use a Jewett otherwise more
complicated needs a more supportive TLSO - ultimately up to the MD. I
think the later is the most important - opinion on stability and
severity of the fx really seems to direct this decision - I have had
orders for a Jewett on multiple level compression fx and single level
burst fx that were successfull in a Jewett. These fx were probably very
stable and only required good postioning to heal. Post you results if
you can. Good luck.

+Hi Mark,
As the manufacturer of The Genuine JewettR brace I would be very
interested
in the responses you receive to your question. Would you be willing
to
share them with us?


+It is a challenge to theorize different specialists groupsa?"orthopedic
versus neurosurgeons. I think it is safe to say when you fabricate a
custom TLSO or custom fitted TLSO the severity of the fracture has to
substantiate the need for maximum stability. Depending on the type of
fracture the most common will be severe compression fracture, or an
unstable fracture that was or not surgically treated and needs stability
on all planes.
a??The Jewett brace is a safe for patients with a mild compression
fracture. The Jewett brace is user friendly and addresses extension of
the spine. This is at the compliance of the patient using the brace
(any brace). I use the Jewett brace for older patients also. A
geriatric patient it is sometimes a wedge compression fracture and not
unstable, but painful. Be empathetic and find a system that the
patient will use versus throw in the closet.
Over the years of doing spinal care for orthopedic and neurosurgery it
amazes me the mind set of the disciplines. It involves where the
physicians did their "internship and fellowship" for the spine. Many
of the medical schools teach different approaches. Some are
conservative and some feel very confident in postsurgical care.
I hope it helps. Have fun in the spinal world of orthotics.

Thanks again to all,

Mark Seibel CPO















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