Review of Current Spinal Robotic Orthoses

Abstract

Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery.

Spine Bracing: When to Utilize—A Narrative Review

“…One randomized control trial went as far as to show that bracing had no significant benefit in improving balance, reducing the dorsal kyphosis angle, or improving the overall quality of life, which is in direct contrast to the benefits reported prior [ 92 ]. Aside from not improving health outcomes, bracing has even been reported to worsen outcomes in osteoporotic patients as prolonged spinal restriction can decondition both thoracic and paraspinal muscles, resulting in atrophy, consequently increasing the risk of future falls and fractures by extension [ 93 ]. Thus, the consensus on bracing’s efficacy in reliably treating adult hyperkyphosis is still unclear.…”

“…Additionally, 3D printing could drive down costs of both plaster and plastic/metal orthoses with in-house operations [ 144 ]. Advances in robotics have also introduced motorized exoskeleton technology to treat OVFs and chronic back pain with great promise, but are currently un-tested and expensive [ 93 ].…”