Spinal Orthotic Devices

0001The present invention relates to the field of spinal orthotic devices, which are configured as elements of a modular system.

0002Such a spinal orthotic device is known from Unexamined German Patent DE 103 29 454 A1, among others.

0003Various symptoms in the spinal area are treated with a variety of orthotic devices which support and/or align the spine in the affected portions and/or restrict its mobility in the various planes. The supporting behavior and the stiffness of the orthotic device are determined by the patient's progress in recovery. In the past, new orthotic devices would be prescribed repeatedly in the course of recovery so that their supporting behavior or rigidity would take into account the patient's indication as well as the patient's current progress in recovery.

0004To reduce costs for medical insurance carriers, modular systems for orthotic devices that can be adapted approximately to the area of the spine to be supported have been developed. An example of such a modular system is known from DE 103 29 454 A1.

0005However, the modular system known previously does not meet all the demands of flexibility and adaptability. For example, the known modular system does not allow optional support in the sagittal plane or simultaneous support in both sagittal and frontal planes. In addition, there are no provisions for adapting the rigidity of the support to the particular progress during recovery. Finally, the modular system known in the past does not allow fine adjustment of the orthotic device that is to be configured to the particular body size of the wearer in fine increments.

0006Therefore, the object of the present invention is to provide a modular system for spinal orthotic devices such that its spinal orthotic devices can be adapted flexibly to a great extent to the particular symptoms and the patient's progress in recovery. With the smallest possible number of elements, the largest possible variety of orthotic devices should configurable so that they can be used with a variety of diseases and their supporting properties can be increased or decreased.

0007This object is achieved by a modular system having the technical features of Claim <b>1</b>. The object for which patent protection is sought is such a spinal orthotic device that can be configured using this modular system, although the spinal orthotic device cannot make use of all elements of the modular system in principle.

0008The seven elements described in Claim <b>1</b> (see also a1) to c1), e1), g1), h1) and i1))—the lower abdominal corset (also known as a lumbar spinal corset), the upper abdominal corset (also known as a shoulder strap system), the corset supporting element (also known as a basic truss pad), the thoracic corset (also known as a thoracic orthotic or thoracic orthotic device), the curved supporting clasp on a corset supporting element, the supporting element and the abdominal truss pad—constitute the basic elements of the basic modular system from which the inventive orthotic devices can be configured. Some of the basic elements of the modular kit are needed for various orthotic devices and thus are reusable if the patient needs a different orthotic device. The modular system also allows therapeutically correct training of the spine, wherein elements are removed successively from a more complex orthotic device, which is thus dismantled incrementally. If there is a delay in recovery, it is possible at any time to return an orthotic device that has been removed too soon, to thereby return to a higher level of support.

0009The advantage of this fundamental modular system may be regarded as the fact that with a minimal number of elements, as listed in Claim <b>1</b>, a wide variety of orthotic devices can be assembled for the particular application case. The respective orthotic devices can be adapted in a flexible manner to each patient's particular medical and physical needs with an accurate fit. Expedient embodiments of the first basic modular system of a spinal orthotic device are characterized in subordinate Claims <b>2</b> to <b>9</b>.

0010The essential difference from the second basic exemplary embodiment according to the additional Claims <b>10</b> to <b>15</b> may be regarded as the fact that additional elements must be added to make the particular orthotic devices expandable among one another. For example, an additional connecting element is used in the second basic exemplary embodiment. Furthermore, the corset supporting elements are designed as truss pads (also called pelotte) in a complex manner. A basic truss pad (also called basic pelotte) is used as the corset supporting element in the second basic exemplary embodiment.

0011The nine elements described in Claim <b>10</b> (see a2) to i2))—the lower abdominal corset, the upper abdominal corset, the basic truss pad, the lumbar extension for the basic truss pad, the thoracic corset, the connecting element, the bridging frame, the supporting element and the abdominal truss pad—are the basic elements of the additional modular system with which at least seven different orthotic devices can be configured according to this invention. Some of the basic elements of the modular kit are needed for different orthotic devices and are thus reusable if the patient needs a different orthotic device. The modular system also allows therapeutically correct training in that elements are removed successively from a more complex orthotic device, which is therefore decreased incrementally. It is possible at any time to reassemble the orthotic device that has been removed too soon in the event of a delay in recovery in order to thereby return to a higher level of support.

0012Expediently a sectional truss pad, which is known per se, is selected as the basic truss pad, comprising four sections joined together in an articulated fashion and arranged along the lumbar spine, transversely bridging the third to fifth lumbar vertebra and the first sacral vertebra. Such a sectional truss pad has proven excellent in therapeutic practice in comparison with other truss pads.

0013Since the joints of the sectional truss pad usually also allow a certain mobility of the individual sections in relation to one another in the sagittal plane, it is advisable to provide a fixation element within the modular system, so that it can be placed in a posterior position on the sectional truss pad, so that the sections of the truss pad are secured immovably in relation to one another in the sagittal plane.

0014A suitable lumbar extension for a sectional truss pad comprises two sections that can be connected together in an articulated manner plus two supporting rails, where the sections of the lumbar extension can be inserted into the sectional truss pad in such a way that the sections of the sectional truss pad, which has been extended by the lumbar extension, bridge the first to fifth lumbar vertebrae as well as the first sacral vertebra transversely and the supporting rails can be placed laterally on the sectional truss pad in such a way that at least the sections bridging the first four lumbar vertebrae are secured immovably in relation to one another. The lumbar extension for a sectional truss pad is thus not attached to the existing sectional truss pad to also include vertebrae L<b>1</b> and L<b>2</b>, but instead is inserted into the sectional truss pad, so that the section that was assigned to L<b>3</b> in the basic configuration now bridges L<b>1</b>. One section of the lumbar extension is allocated to L<b>2</b>, while the other section of the lumbar extension continues to support L<b>3</b>.

0015To make the supporting rigidity of the bridging frame more adjustable, it is advisable to provide a tenth element in the form of reinforcing rods that can be secured on the bridging frame to adjust the rigidity.

0016Additional measures that improve the present invention are characterized in the subordinate claims or are presented below and explained in greater detail jointly with the description and the preferred exemplary embodiments of the invention on the basis of the figures. FIGS. <b>1</b> to <b>12</b> illustrate the first basic modular system for spinal orthotic devices. The additional FIGS. <b>13</b> to <b>28</b>, however, additionally disclose the fundamental modular system for spinal orthotic devices:

0017<figref idref="DRAWINGS">FIG. 1</figref> shows a rear view of a first variant of an inventive thoracic vertebral orthesis without a shoulder strap system,

0018<figref idref="DRAWINGS">FIG. 2</figref> shows a front view of another inventive variant of the thoracic vertebral orthesis with a shoulder strap system and a strap-like supporting element,

0019<figref idref="DRAWINGS">FIG. 3</figref><i>a </i>shows a front view of a strap-like support element,

0020<figref idref="DRAWINGS">FIG. 3</figref><i>b </i>shows a side view of the supporting element from <figref idref="DRAWINGS">FIG. 3</figref><i>a, </i>

0021<figref idref="DRAWINGS">FIG. 3</figref><i>c </i>shows cross section I-I through the supporting element from <figref idref="DRAWINGS">FIG. 3</figref><i>a, </i>

0022<figref idref="DRAWINGS">FIG. 4</figref><i>a </i>shows a front view of another supporting element,

0023<figref idref="DRAWINGS">FIG. 4</figref><i>b </i>shows a front view of another supporting element,

0024<figref idref="DRAWINGS">FIG. 5</figref><i>a </i>shows a front view of a corset supporting element,

0025<figref idref="DRAWINGS">FIG. 5</figref><i>b </i>shows a side view of the corset supporting element from <figref idref="DRAWINGS">FIG. 5</figref><i>a, </i>

0026<figref idref="DRAWINGS">FIG. 5</figref><i>c </i>shows a rear view of the corset supporting element from <figref idref="DRAWINGS">FIG. 5</figref><i>a, </i>

0027<figref idref="DRAWINGS">FIG. 6</figref> shows a front view of an assembled supporting element with a corset supporting element and/or a coupling member with a counter-coupling member,

0028<figref idref="DRAWINGS">FIG. 7</figref> shows a three-dimensional view of an assembled supporting element with a corset supporting element, two curved supporting clasps being arranged thereon,

0029<figref idref="DRAWINGS">FIG. 8</figref> shows a three-dimensional view of an adapter part,

0030<figref idref="DRAWINGS">FIG. 9</figref> shows a three-dimensional view of an inventive vertebral orthesis without the curved supporting clasp,

0031<figref idref="DRAWINGS">FIG. 10</figref> shows a three-dimensional view of a thoracolumbar orthotic device,

0032<figref idref="DRAWINGS">FIG. 11</figref> shows a three-dimensional view of a lumbar vertebral corset and

0033<figref idref="DRAWINGS">FIG. 12</figref><i>a </i>shows a front view of a belt holder and

0034<figref idref="DRAWINGS">FIG. 12</figref><i>b </i>shows section II-II through the belt holder from <figref idref="DRAWINGS">FIG. 12</figref><i>a. </i>

0035<figref idref="DRAWINGS">FIG. 13</figref> shows a sectional truss pad;

0036<figref idref="DRAWINGS">FIG. 14</figref> shows stabilizing orthotic device;

0037<figref idref="DRAWINGS">FIG. 15</figref> shows a sectional truss pad with a lumbar extension;

0038<figref idref="DRAWINGS">FIG. 16</figref> shows a fixation element;

0039<figref idref="DRAWINGS">FIG. 17</figref> shows a lumbar orthotic device;

0040<figref idref="DRAWINGS">FIG. 18</figref> shows a supporting element;

0041<figref idref="DRAWINGS">FIG. 19</figref> shows a connecting element;

0042<figref idref="DRAWINGS">FIG. 20</figref> shows a sectional truss pad with a lumbar extension, a connecting element and a supporting element;

0043<figref idref="DRAWINGS">FIG. 21</figref> shows a thoracic orthotic device;

0044<figref idref="DRAWINGS">FIG. 22</figref> shows a spinal orthotic device sagittally;

0045<figref idref="DRAWINGS">FIG. 23</figref> shows a supporting frame with reinforcing rods;

0046<figref idref="DRAWINGS">FIG. 24</figref> shows a bridging orthotic device;

0047<figref idref="DRAWINGS">FIG. 25</figref> shows an abdominal truss pad;

0048<figref idref="DRAWINGS">FIG. 26</figref> shows a flexion orthotic device;

0049<figref idref="DRAWINGS">FIG. 27</figref> shows a bridging frame with supporting elements;

0050<figref idref="DRAWINGS">FIG. 28</figref> shows an osteoporosis orthotic device.

0051<figref idref="DRAWINGS">FIG. 1</figref> shows an inventive thoracic spinal orthotic device <b>10</b>, as seen in a view from the rear. The triangular posterior part <b>11</b> is shown with very rounded corners and also with stripes <b>12</b> in the form of cloth strips or parts of a hook-and-loop fastener (also called VELCRO-type closure parts). This posterior part <b>11</b> is designed to be in symmetry with the spine and/or a vertical line. On the cranial end of the posterior part <b>11</b> two inelastic belts <b>14</b> of the shoulder belt system <b>13</b> are arranged in the area of the spine. Belt holders <b>15</b> consisting essentially of a closed curved plastic part are used here. These belt holders <b>15</b> are attached to the posterior part <b>11</b> by elastic bands <b>16</b>. The elastic bands <b>16</b> run diagonally away from the spine, with the bands arranged in an ascending pattern to the shoulder. The inelastic belts <b>14</b> of the shoulder belt system <b>13</b> are arranged on the belt holders <b>15</b>. These run toward the lower belt holders <b>15</b> which are also arranged on the posterior part <b>11</b> via elastic bands <b>16</b>. The lower belt holders <b>15</b> are arranged a greater distance away from the spine on the posterior part <b>11</b>, so as not to leave too much clearance for the shoulder belt system <b>13</b> due to the elastic bands <b>16</b>. Thus, only short elastic bands <b>16</b> are used and may be attached to the posterior part <b>11</b> by sewing or gluing. The caudal belt holders <b>15</b> have guide straps <b>35</b> which are shown separately in <figref idref="DRAWINGS">FIGS. 12</figref><i>a </i>and <b>12</b><i>b. </i>

0052For ventral fastening of the thoracic spinal orthotic device <b>10</b>, a shoulder strap system <b>17</b> is provided, including a belt <b>18</b> not shown in <figref idref="DRAWINGS">FIG. 1</figref>. This shoulder strap system <b>17</b> may be attached to the posterior part <b>11</b> by the double wall-fastening tabs <b>29</b> (shown in <figref idref="DRAWINGS">FIG. 1</figref>). To do so, the fastening tabs <b>29</b> are provided with corresponding VELCRO-type closure parts on the inside which cooperate with mating VELCRO-type closure parts on the belts <b>18</b> of the shoulder strap system <b>17</b>. The belts <b>18</b> are arranged on the fastening tab <b>29</b> via the stationary belt ends <b>19</b>. To shorten the belts <b>18</b> to the required length, it is possible to simply cut off the stationary belt ends <b>19</b> accordingly. The shoulder strap system <b>17</b> is closed ventrally with a VELCRO-type closure, for example, via the open belt ends <b>20</b>. A supporting element <b>23</b> that is provided is arranged preferably on the side of the posterior part <b>11</b> facing the back and therefore is not visible in <figref idref="DRAWINGS">FIG. 1</figref>.

0053<figref idref="DRAWINGS">FIG. 2</figref> shows another inventive thoracic spinal orthotic device <b>10</b>. Supporting element <b>23</b> arranged inside the pocket <b>21</b> can be seen clearly here. This supporting element <b>23</b> is designed with a bow shape, in particular a U shape, but the U is upside down. The cranial end <b>24</b> of the supporting element <b>23</b> as well as the caudal ends <b>25</b> of the supporting element <b>23</b> are arranged in closable pockets <b>21</b>. These pockets <b>21</b> can be closed by VELCRO-type closures <b>22</b> in the present case. With the thoracic spinal orthotic device <b>10</b> shown in <figref idref="DRAWINGS">FIG. 2</figref>, the shoulder strap system <b>17</b> is inseparably connected to the posterior part <b>11</b>. Consequently, the fastening tabs <b>29</b> for holding the shoulder strap system <b>17</b>, in particular the belt <b>18</b>, are not used here. As can also be seen here, the supporting element <b>23</b> has a recess <b>26</b> between the two rod-like ends <b>25</b> to be able to accommodate the spine in this recess. This thoracic spinal orthotic device <b>10</b> is fully usable in the condition shown in <figref idref="DRAWINGS">FIG. 2</figref>. Other supporting elements <b>23</b> may of course also be used, e.g., secured in a stationary position on the posterior part <b>11</b> in the form of truss pads. It is also conceivable to reinforce these supporting elements <b>23</b> with additional reinforcing elements.

0054<figref idref="DRAWINGS">FIG. 3</figref><i>a </i>shows a curved supporting element <b>23</b> which at the same time serves as a coupling section. The curved supporting element <b>23</b> is designed to be closed on its cranial end <b>24</b>. However the supporting element <b>23</b> has two open caudal ends <b>25</b> which at the same time serve to connect the supporting element <b>23</b> to a corset supporting element <b>41</b> (not shown). There is a recess <b>26</b> which is wide enough for the spine between these two rod-shaped caudal ends <b>25</b> of the supporting element <b>23</b>.

0055<figref idref="DRAWINGS">FIG. 3</figref><i>b </i>shows a side view of the curved supporting element <b>23</b>. This shows clearly that the supporting element <b>23</b> is bent at an angle (see angle ∀) approximately at the center, so that the supporting element <b>23</b> should follow a healthy curve of the thoracic spine. In addition, this view shows a curve <b>27</b> on the cranial end <b>24</b> of the supporting element <b>23</b>. This curve <b>27</b> also serves to prevent contact between the supporting element <b>23</b> and the thoracic spine.

0056<figref idref="DRAWINGS">FIG. 3</figref><i>c </i>shows the cross section I from <figref idref="DRAWINGS">FIG. 3</figref><i>a</i>. Again in this diagram, the curve <b>27</b> for the spine on the cranial end <b>24</b> of the supporting element <b>23</b> can be seen clearly. In addition, it is apparent that the supporting element <b>23</b> is designed to be extremely flat to ensure a high wearing comfort for the thoracic spinal orthotic device. Consequently, the abovementioned reinforcing elements can be attached to the flat caudal ends <b>25</b> with no problem.

0057<figref idref="DRAWINGS">FIGS. 4</figref><i>a </i>and <b>4</b><i>b </i>show other supporting elements <b>23</b> in different embodiments. <figref idref="DRAWINGS">FIG. 4</figref><i>a </i>also shows a strap-shaped supporting element <b>23</b>, where additional transverse struts connect the caudal ends <b>25</b> of the supporting element <b>23</b>, which may also have curves <b>27</b>. Thus an increased stability of the supporting element <b>23</b> is achieved. Furthermore, this also facilitates the fastening of the supporting element <b>23</b> to the posterior part <b>11</b> and/or the pockets <b>21</b>. The bottom transverse struts may serve as a stop element for the counter-coupling element <b>48</b>.

0058<figref idref="DRAWINGS">FIG. 4</figref><i>b </i>shows two identical rod-shaped supporting elements <b>23</b> in a view from above. This supporting element <b>23</b> also has transverse struts for the longitudinal profile of the supporting element <b>23</b>. Such a supporting element <b>23</b> may be arranged on the right and left sides of the spine. Here again, the caudal end <b>25</b> of the supporting element <b>23</b> provides the connection to the corset supporting element <b>41</b>. Two corset supporting elements <b>41</b> with suitable designs are expediently also used as counter-coupling elements <b>48</b> when two rod-shaped supporting elements <b>23</b> are used, as shown in <figref idref="DRAWINGS">FIG. 4</figref><i>b</i>. The transverse struts mentioned above may serve as stops here so that the rod-shaped supporting elements <b>23</b> can cooperate with the corset supporting element <b>41</b> only to a predetermined depth.

0059<figref idref="DRAWINGS">FIG. 5</figref><i>a </i>shows a frame-like corset supporting element <b>41</b>. This frame part has two longitudinal rods which are connected to one another with a total of three transverse struts. A receptacle area <b>46</b> is provided on the cranial end <b>42</b> of the corset supporting element <b>41</b> to be able to accommodate a corresponding supporting element <b>23</b> in a form-fitting connection. The receptacle area <b>46</b> consists of a passage or a bore through which the rod-shaped flat ends <b>25</b> of the supporting element <b>23</b> can be passed. In this way, the coupling element <b>28</b> which consists of the supporting element <b>23</b> with the counter-coupling element <b>48</b> which is embodied by the corset element <b>41</b> can be telescoped together. The supporting elements <b>23</b> and <b>41</b> which are thus joined together provide adequate stability for the spine in the sagittal plane.

0060<figref idref="DRAWINGS">FIG. 5</figref><i>b </i>shows a side view of the frame-like corset supporting element <b>41</b> from <figref idref="DRAWINGS">FIG. 5</figref><i>a</i>. It is clear here that the transverse struts are also guided in a curve <b>45</b> around the spine. Recesses <b>44</b> are also provided in the frame-like corset supporting element <b>41</b> to provide adequate room for the spine. <figref idref="DRAWINGS">FIG. 5</figref><i>c </i>shows a rear view of the corset supporting element <b>41</b> from <figref idref="DRAWINGS">FIG. 5</figref><i>a. </i>

0061<figref idref="DRAWINGS">FIG. 6</figref> shows the assembled coupling element <b>28</b> with the counter-coupling element <b>48</b>. The coupling element <b>28</b> is inserted with the caudal ends <b>25</b> into passages <b>46</b> in the counter-coupling element <b>48</b>. Thus the supporting element <b>23</b> and/or the coupling element <b>28</b> is joined to the corset supporting element <b>41</b> and/or the counter-coupling element <b>48</b> in a form-fitting connection. In this way, the required stability of the thoracic spinal orthotic device in the sagittal plane is achieved. In addition, other receptacle areas <b>45</b> may be provided in the counter-coupling element <b>48</b> to increase the stability of the two supporting elements <b>23</b> and <b>24</b> that are joined together. In addition, an adapter part <b>30</b> may also be used. In the present example from <figref idref="DRAWINGS">FIG. 6</figref>, the frame-like corset supporting element <b>41</b> has additional reinforcing elements.

0062<figref idref="DRAWINGS">FIG. 7</figref> shows another example of a supporting element <b>23</b> and a corset supporting element <b>41</b>. In addition, an adapter part <b>30</b> is used here to improve the stability of the connection between the coupling element <b>28</b> and the counter-coupling element <b>48</b>. This adapter part <b>30</b> is held so that it is longitudinally displaceable on the rods of the frame-like corset supporting element <b>41</b>. In addition, the adapter part <b>30</b> has two different receptacle areas <b>31</b> and <b>32</b>. The receptacle area <b>31</b> provides a form-fitting receptacle for the supporting element <b>23</b> whereas the receptacle area <b>32</b> provides a form-fitting receptacle for the corset supporting element <b>41</b>. Furthermore, two curved supporting clasps <b>47</b> are arranged on the frame-like corset supporting element <b>41</b>. The corset supporting element <b>41</b> from <figref idref="DRAWINGS">FIG. 7</figref> in the present case is itself designed in two parts, with the two parts being connected by the rod-shaped elements of the corset supporting element <b>41</b>. Due to the two-part design of the corset supporting element <b>41</b>, an adjustment in size is possible, so that this orthotic device, in particular the thoracolumbar orthotic device, is designed to be optimally adaptable to the patient's body. Due to the two-part corset supporting element <b>41</b> with the curved supporting clasps <b>47</b>, the spine is supported not only in the sagittal plane but also in the frontal plane. As this shows clearly, the curved supporting clasps <b>47</b> are arranged orthogonally to the two longitudinal rods of the corset supporting element <b>41</b>. The curved supporting clasp <b>47</b> may be connected to the respective longitudinal rods of the corset supporting element <b>41</b> so they are made of the same material in one piece. The open ends of the longitudinal rods of the corset supporting element <b>41</b> can be joined together in a form-fitting manner by means of catch means and counter-catch means. It is also conceivable to join the aforementioned ends together via hook-and-loop fasteners (also called VELCRO-type closures) or pushbuttons or the like.

0063<figref idref="DRAWINGS">FIG. 8</figref> shows a three-dimensional view of the adapter element <b>30</b>. The receptacle areas <b>32</b> for the rod-shaped ends of the corset supporting element <b>41</b> are arranged in the right and left sides. They consist essentially of a passage designed to be rectangular. The receptacle areas <b>31</b> for the open rod-shaped ends of the supporting element <b>23</b> are connected to the receptacle areas <b>32</b>. These receptacle areas <b>31</b> also have rectangular passages. In order for the adapter part <b>30</b> not to press against the patient's spine, a central recess <b>33</b> is also provided, connected to the receptacle areas <b>31</b> on the right and left sides toward the inside. <figref idref="DRAWINGS">FIG. 7</figref> illustrates the use of the adapter part <b>30</b>. As already mentioned, this adapter part <b>30</b> is attached to the rod-shaped ends of the corset supporting element <b>41</b> so that it is adjustable in height. The caudal ends <b>25</b> of the supporting element <b>23</b> may protrude variably into the receptacle area <b>31</b> of the adapter part <b>30</b>. The stability of the assembled supporting elements <b>23</b> and <b>24</b> can be varied merely through the adjustability in height of the adapter part <b>30</b>. The adapter part <b>30</b> may itself be made of plastic or a metal part, in particular a light metal alloy.

0064<figref idref="DRAWINGS">FIG. 9</figref> shows a spinal orthotic device <b>50</b>. This spinal orthotic device <b>50</b> is obtained by joining the thoracic spinal orthotic device <b>10</b> with the lumbar spinal corset <b>40</b>. First, the supporting element <b>23</b>, and secondly, the corset supporting element <b>41</b>, which together form a coupling element <b>28</b> and a counter-coupling element <b>48</b>, serve to couple the thoracic spinal orthotic device <b>10</b> and the lumbar spinal corset <b>40</b>. The supporting element <b>23</b> is arranged in a stationary position in the posterior part <b>11</b> in the pocket <b>21</b>. The corset supporting element <b>41</b> can be secured by a comparable pocket on the inside of the lumbar spinal corset. It is also conceivable, as in the present case, to attach the frame-like corset supporting element <b>41</b> by means of VELCRO-type fasteners <b>34</b>. It should be pointed out here that both the supporting element <b>23</b> and the corset supporting element <b>41</b> can be secured by means of other connecting means such as pushbuttons, catch means and counter-catch means, for example. The spinal orthotic device <b>50</b> shown in <figref idref="DRAWINGS">FIG. 9</figref> supports the spine exclusively in the sagittal plane.

0065The thoracic spinal orthotic device <b>10</b> shown in <figref idref="DRAWINGS">FIG. 9</figref> is connected to the lumbar spinal corset <b>40</b> by additional connecting elements, e.g., VELCRO-type closures. However, this does not provide any support for the spine. Instead, a corresponding adjustment in the spinal orthotic device to the patient's body size is possible. To this end, the coupling element <b>28</b> is also adjustable in relation to the counter-coupling element <b>48</b>.

0066<figref idref="DRAWINGS">FIG. 10</figref> shows a thoracolumbar orthotic device <b>60</b>. With this orthotic device <b>60</b>, the combination of the supporting element <b>23</b> is used with the corset supporting element <b>41</b> from <figref idref="DRAWINGS">FIG. 7</figref>. Thus the thoracolumbar orthotic device <b>60</b>, which consists of the thoracic spinal orthotic device <b>10</b>, a shoulder strap system <b>17</b> with the lumbar spinal corset <b>40</b>, supports the patient's spine in the sagittal and frontal planes. The thoracic spinal orthotic <b>10</b> is joined via the coupling element <b>28</b> and the counter-coupling element <b>48</b>. In addition, other connecting means are also provided in the form of VELCRO-type closures, pushbuttons or the like. The counter-coupling element <b>48</b> is held on the lumbar spinal corset <b>40</b> in a form-fitting manner by means of VELCRO-type closures <b>34</b>. The corset supporting element <b>41</b> in the present case has two curved supporting clasps <b>47</b> which are arranged orthogonally to the rods of the corset supporting element <b>41</b>.

0067<figref idref="DRAWINGS">FIG. 11</figref> shows a complete usable lumbar spinal corset <b>40</b>. This may be connected cranially to a shoulder strap system <b>17</b> and/or an upper abdominal corset <b>17</b>. This shoulder strap system <b>17</b> can in turn be connected cranially to the thoracic spinal orthotic device <b>10</b>. The lumbar spinal corset <b>40</b> can also be used alone if the patient has problems only in the area of the lumbar spine. To this end, the corset supporting element <b>41</b> may be secured on the inside of the lumbar spinal corset <b>40</b>, in particular in a form-fitting manner. Pockets <b>21</b> or VELCRO-type closures <b>34</b> may be used for the arrangement of the corset supporting element <b>41</b>. The lumbar spinal corset <b>40</b> may be supplemented cranially by the thoracic orthotic device <b>10</b> to form a thoracic/lumbar orthotic device.

0068<figref idref="DRAWINGS">FIGS. 12</figref><i>a </i>and <b>12</b><i>b </i>show a belt holder <b>15</b> with a guide strap <b>35</b>. This guide strap <b>35</b> has at least two pull-through straps <b>36</b> that are separate from one another and are designed to be wide but narrow to be able to accommodate the inelastic belt <b>14</b> and/or the elastic belt <b>16</b>. As <figref idref="DRAWINGS">FIG. 12</figref><i>a </i>shows, the corners <b>38</b> of the respective pull-through strap <b>36</b> are rounded. In addition, these corners <b>38</b> may also be designed to be reinforced to avoid tears or cuts in the belts and/or belts to chafed areas. In addition, a sewed-on tab <b>37</b> is provided on the guide strap <b>35</b>, this tab having approximately the same width as the inelastic belt <b>14</b>. This sewed-on tab <b>37</b> serves to allow additional sewing of the elastic belt <b>16</b> to the guide strap <b>35</b> to prevent the elastic belt <b>16</b> from bunching up on the belt holder <b>15</b>.

0069<figref idref="DRAWINGS">FIG. 12</figref><i>b </i>shows section II from <figref idref="DRAWINGS">FIG. 2</figref><i>a</i>, which clearly shows the separation of the two pull-through straps <b>36</b>. The wedge-shaped course of the sewed-on tab <b>37</b>, which is designed to decrease in size away from the guide strap <b>35</b> can also be seen here.

0070<figref idref="DRAWINGS">FIGS. 14, 17</figref>, <b>21</b>, <b>22</b>, <b>24</b>, <b>26</b> and <b>28</b> show seven different orthotic devices that can be configured out of this modular system. The other figures show individual elements of the modular system that do not yet form a wearable orthotic device.

0071An essential basic element of the second basic modular system is the basic truss pad in the form of a sectional truss pad <b>110</b>, as shown in <figref idref="DRAWINGS">FIG. 13</figref>. This consists of four sections <b>111</b> joined together with an articulation, each section being assigned to one vertebra. The bottom section is assigned to the first sacral vertebra (S<b>1</b>), and the three other sections are assigned to the third to fifth lumbar vertebrae (L<b>3</b>-L<b>5</b>). The sections <b>111</b> are designed in the manner of a bridge, bridging “their” vertebrae transversely and each lying with contact surfaces <b>112</b> on both sides of the vertebra on the back. Laterally the sections <b>111</b> assigned to the lumbar vertebrae do not have insertion ends <b>113</b> on the back onto which supporting rails <b>142</b> of the lumbar extension <b>140</b> described later can be placed. The sections <b>111</b> of the sectional truss pad <b>110</b> can be joined together with an articulation with the help of joints <b>114</b>, so that the individual sections <b>111</b> are movable with respect to one another in all three planes (frontal, sagittal and transverse planes). This mobility is restricted by optional use of a fixation element <b>115</b> as shown in <figref idref="DRAWINGS">FIG. 16</figref> or a connecting element <b>150</b> as shown in <figref idref="DRAWINGS">FIG. 19</figref> posteriorly on the sectional truss pad <b>110</b>. To this end, the individual sections <b>111</b> of the sectional truss pad <b>110</b> have pushbuttons on their backside engaging in recesses <b>151</b> in the fixation element <b>115</b> and/or the connecting element <b>150</b>. The individual sections <b>111</b> of the sectional truss pad <b>110</b> are thereby secured immovably with respect to one another in the sagittal plane so that only a certain freedom of movement in the transverse and frontal planes remains in the lower lumbar area.

0072The sectional truss pad <b>110</b> whose sagittal mobility is restricted by the fixation element <b>115</b> can be secured dorsally in a lower abdominal corset <b>120</b>. This yields the stabilizing orthotic device illustrated in <figref idref="DRAWINGS">FIG. 14</figref>, which supports and aligns the lumbar spinal area. To do so, the lower abdominal corset <b>120</b> is wrapped around the abdomen accordingly and fastened. This basic orthotic device supports and relieves the lower lumbar area.

0073If lordosis of the entire lumbar spine is to be corrected, the sectional truss pad <b>110</b> can be extended by adding a lumbar extension <b>140</b>, as shown in <figref idref="DRAWINGS">FIG. 15</figref>. The lumbar extension <b>140</b> comprises two additional sections <b>141</b> which are incorporated into the existing sectional truss pad <b>110</b>, so that the expanded sectional truss pad <b>110</b> comprises a total of six sections <b>111</b>, <b>141</b>, which cover the entire lumbar area (L<b>1</b>-L<b>5</b>) and the first sacral vertebra (S<b>1</b>). In addition, the lumbar extension <b>140</b> comprises two supporting rails <b>142</b>, which can be attached laterally to the insertion ends <b>113</b> of at least the four sections <b>111</b>, <b>141</b> of the expanded sectional truss pad <b>110</b>, <b>140</b>, bridging the first four lumbar vertebrae. When the supporting rails <b>142</b> are attached, they reinforce the truss pad bandage in all three planes, so that only the sections of the fifth lumbar vertebra and the first sacral vertebra still have free mobility. The patient has only limited mobility within the frontal plane in the area reinforced by the supporting rails <b>142</b>, while sagittal mobility is completely blocked.

0074The sectional truss pad <b>110</b> expanded by the lumbar extension <b>140</b> as illustrated in <figref idref="DRAWINGS">FIG. 15</figref> can be secured dorsally in the lower abdominal corset <b>120</b>. Since this does not extend over the entire lumbar spinal area, it is supplemented cranially by an upper abdominal corset <b>130</b>. The upper and lower abdominal corsets <b>120</b>, <b>130</b> can be secured to one another by VELCRO-type closures. The overlap area between the lower and upper abdominal corsets <b>120</b>, <b>130</b> can be selected freely, so that the corset bandage can be adapted to the patient's body size. To increase the intra-abdominal pressure, an abdominal truss pad <b>190</b> can be secured ventrally in the lower abdominal corset <b>120</b>. The abdominal truss pad <b>190</b> is shown in <figref idref="DRAWINGS">FIG. 13</figref> and will be explained in greater detail below. The orthotic device shown in <figref idref="DRAWINGS">FIG. 17</figref> consisting of the lower abdominal corset <b>120</b>, the upper abdominal corset <b>130</b>, the sectional truss pad <b>110</b>, the lumbar extension <b>140</b>, the fixation element <b>115</b> and the abdominal truss pad <b>190</b> is a lumbar orthotic device that corrects lordosis of the entire lumbar spinal area.

0075If the spine is also to be supported in the thoracic area, then the sectional truss pad <b>110</b> can be expanded with the help of the supporting element <b>160</b> shown in <figref idref="DRAWINGS">FIG. 18</figref>. The supporting element <b>160</b> is essentially U-shaped and extends with its legs along the spine in the thoracic spinal area. At its caudal end, the supporting element <b>160</b> has a securing clamp <b>161</b> on each leg with the help of which the supporting element <b>160</b> can optionally be secured to the connecting element <b>150</b> shown in <figref idref="DRAWINGS">FIG. 19</figref> or to the bridging frame <b>170</b> illustrated in <figref idref="DRAWINGS">FIG. 23</figref> and described below. At its cranial end <b>162</b>, the supporting element <b>160</b> is inserted into a pocket <b>201</b> provided specifically for this purpose and situated posteriorly on a thoracic spinal corset <b>200</b> in the form of a backpack. The thoracic spinal corset <b>200</b> is shown in <figref idref="DRAWINGS">FIG. 21</figref> with the supporting element <b>160</b> inserted. The supporting element <b>160</b> is secured in the pocket <b>201</b> of the thoracic spinal corset <b>200</b>. This orthotic device shown in <figref idref="DRAWINGS">FIG. 21</figref> can be worn separately as a thoracic orthotic.

0076With the help of the supporting element <b>160</b> and the thoracic spinal corset <b>200</b>, the lumbar orthotic device shown in <figref idref="DRAWINGS">FIG. 17</figref> can be converted to the spinal orthotic device illustrated in <figref idref="DRAWINGS">FIG. 22</figref> which stabilizes and aligns the entire spine in the sagittal plane. To do so, first the fixation element <b>115</b> shown in <figref idref="DRAWINGS">FIG. 16</figref> is replaced by the connecting element <b>150</b> shown in <figref idref="DRAWINGS">FIG. 19</figref>. This has a fork-like receptacle <b>152</b> on its cranial end, so that the supporting element <b>160</b> with its securing clamps <b>161</b> can be secured in this receptacle. This forms the supporting structure illustrated in <figref idref="DRAWINGS">FIG. 20</figref>. This can be adapted to the patient's body size by inserting the securing clamps <b>121</b> inside the fork-like receptacle <b>152</b> of the connecting element <b>150</b> to the required length.

0077Finally, the thoracic spinal corset <b>200</b> is secured cranially to the lower abdominal corset <b>120</b> instead of the upper abdominal corset <b>130</b> and the supporting structure shown in <figref idref="DRAWINGS">FIG. 20</figref> is inserted posteriorly into the overall corset consisting of the lower abdominal corset <b>120</b> and the thoracic spinal corset <b>110</b>. In this way, the spinal orthotic device illustrated in <figref idref="DRAWINGS">FIG. 22</figref> is formed, bridging the spinal area in question from the pelvic ridge up to and including the thorax, relieving stress on the spine, stabilizing and aligning the entire spinal area in the sagittal plane. In the lumbar spine area, the sectional truss pad <b>110</b> expanded by the lumbar extension <b>140</b> and the stabilized connecting element <b>150</b> ensure correction of lordosis. Alignment of the thoracic spine is achieved due to the supporting element <b>160</b> used in the upper area and hyperkyphosis is reduced. Likewise, the lumbar lordosis is greatly reduced due to the spinal orthotic device illustrated in <figref idref="DRAWINGS">FIG. 22</figref> and the thoracic spine is thereby aligned. Because of the modular design, the orthotic device can be scaled back at any time in certain spinal areas by removing the respective supporting elements as improvement occurs, so that a therapeutically correct training effect is achieved. If the complaints exacerbate again subsequently, it is possible to return to the complete spinal orthotic device at any time.

0078The complaints caused by osteoporosis in particular require alignment of the spine and stress relief in the sagittal and frontal planes. To this end, the modular system has a bridging frame <b>170</b> as illustrated in <figref idref="DRAWINGS">FIG. 23</figref>, connectable into a bandage consisting of the upper and lower abdominal corsets <b>120</b> and <b>130</b>, thus yielding the bridging orthotic device shown in <figref idref="DRAWINGS">FIG. 24</figref>. The bridging frame <b>70</b> consists essentially of two II-shaped half elements <b>171</b>. At its caudal and/or cranial ends, the half elements <b>171</b> have a curved carrier <b>172</b> that surrounds the lower thorax and/or the pelvis in a supportive manner. Two connecting struts <b>173</b> extend away from the carriers <b>172</b> along the spine in the direction of the other half element <b>172</b>. The connecting struts <b>173</b> are equipped with VELCRO-type closures and may thus be attached to one another so that the spacing of the carriers <b>172</b> can be adapted to the patient's body size. Furthermore, additional reinforcing rods <b>180</b> can be attached to the connecting struts <b>173</b>, so that these rods can be inserted into corresponding pockets <b>174</b> on the carriers <b>172</b>. By inserting the reinforcing rods <b>180</b> the stiffness of the bridging frame <b>170</b> can be adapted to the particular progress in recovery by the respective patient.

0079For precision adjustment of the stiffness, different materials such as plastic or metal may be provided for the reinforcing rods <b>180</b>.

0080To convert the bridging orthotic device shown in <figref idref="DRAWINGS">FIG. 24</figref> into a flexion orthotic device as shown in <figref idref="DRAWINGS">FIG. 26</figref>, an abdominal truss pad <b>190</b>, which is shown in a side view in <figref idref="DRAWINGS">FIG. 25</figref>, is secured ventrally in the lower abdominal corset <b>120</b>. The abdominal truss pad <b>190</b> comprises a pressure plate <b>191</b>, whose concave curvature is adjusted with the help of two strips of a VELCRO-type closure <b>192</b>. By appropriate prestressing of the VELCRO-type closure <b>192</b>, the convex profile of the pressure plate <b>191</b> is adapted to the desired extent. The entire abdominal truss pad <b>190</b> can be secured ventrally in the lower abdominal corset <b>120</b> via the VELCRO-type closure <b>192</b>.

0081With the help of the U-shaped supporting element <b>160</b> and the thoracic spinal corset <b>200</b>, the bridging orthotic device shown in <figref idref="DRAWINGS">FIG. 24</figref> can be equipped to form an osteoporosis orthotic device as illustrated in <figref idref="DRAWINGS">FIG. 28</figref>, stabilizing and aligning the entire spinal area from the pelvic ridge up to an including the thorax in the sagittal and frontal planes. To do so, the supporting element <b>160</b> known from <figref idref="DRAWINGS">FIG. 18</figref> is attached with its securing clamps <b>61</b> to the connecting struts <b>173</b> of the frame <b>130</b>. A height adjustment is possible with no problem through free choice of the connection point. The resulting bandage illustrated in <figref idref="DRAWINGS">FIG. 27</figref> is attached caudally to the lower abdominal corset <b>120</b> and cranially to the thoracic spinal corset <b>200</b>, which is likewise attached to the lower abdominal corset <b>120</b>. Furthermore, the supporting element <b>160</b> is inserted at its cranial end <b>162</b> into the pocket <b>201</b> provided for this purpose on the thoracic spinal corset <b>200</b>, so that ultimately the osteoporosis orthotic device illustrated in <figref idref="DRAWINGS">FIG. 28</figref> is obtained.

0082Thanks to the bridging frame <b>170</b> which is adjustable in height, this orthotic device ensures a definite lordosis correction which counteracts the compensatory hyperlordosis. An alignment of the thoracic spine is achieved due to the supporting element <b>160</b> inserted in the upper area and this greatly reduces the hyperkyphosis. In addition, the lumbar lordosis is definitely corrected and the thoracic spine is aligned. In contrast with other osteoporosis orthotic devices, due to the modular character of the orthotic device configured from this modular system, a later reduction to the particular painful diseased area in question is possible. For example, if relief is achieved in the lumbar area, the lower abdominal corset <b>120</b> is removed together with the supporting frame <b>170</b> and thereafter only the thoracic spinal corset <b>100</b> with the inserted supporting element <b>160</b> is worn, as illustrated in <figref idref="DRAWINGS">FIG. 19</figref>. Furthermore, therapeutic corrective training of the spine is possible through various stages of therapy due to the use of initially rigid reinforcing rods <b>180</b> on the bridging frame <b>170</b> and then later using flexible reinforcing rods. Then if the symptoms are exacerbated again later, a return to the complete spinal orthotic device would be possible at any point in time.

LIST OF REFERENCE NOTATION

0000<ul id="ul0003" list-style="none"><li id="ul0003-0001" num="0000"><ul id="ul0004" list-style="none"><li id="ul0004-0001" num="0083"><b>10</b> thoracic orthotic device </li><li id="ul0004-0002" num="0084"><b>11</b> posterior part </li><li id="ul0004-0003" num="0085"><b>12</b> strips of cloth </li><li id="ul0004-0004" num="0086"><b>13</b> shoulder belt system </li><li id="ul0004-0005" num="0087"><b>14</b> inelastic belt </li><li id="ul0004-0006" num="0088"><b>15</b> belt holder </li><li id="ul0004-0007" num="0089"><b>16</b> elastic belt </li><li id="ul0004-0008" num="0090"><b>17</b> shoulder strap system </li><li id="ul0004-0009" num="0091"><b>18</b> belt </li><li id="ul0004-0010" num="0092"><b>19</b> stationary belt end </li><li id="ul0004-0011" num="0093"><b>20</b> open belt end, e.g., with parts of hook-and-loop fastener (also called VELCRO-type closure parts) </li><li id="ul0004-0012" num="0094"><b>21</b> pocket </li><li id="ul0004-0013" num="0095"><b>22</b> hook-and-loop fastener (also called VELCRO-type closure) for pocket </li><li id="ul0004-0014" num="0096"><b>23</b> supporting element </li><li id="ul0004-0015" num="0097"><b>24</b> cranial end of the supporting element </li><li id="ul0004-0016" num="0098"><b>25</b> caudal end of the supporting element </li><li id="ul0004-0017" num="0099"><b>26</b> recess in the supporting element </li><li id="ul0004-0018" num="0100"><b>27</b> curve (around the spine) in the supporting element </li><li id="ul0004-0019" num="0101"><b>28</b> coupling element </li><li id="ul0004-0020" num="0102"><b>29</b> fastening tabs </li><li id="ul0004-0021" num="0103"><b>30</b> adapter part </li><li id="ul0004-0022" num="0104"><b>31</b> receptacle area for <b>23</b></li><li id="ul0004-0023" num="0105"><b>32</b> receptacle area for <b>41</b></li><li id="ul0004-0024" num="0106"><b>33</b> recess in the adapter part </li><li id="ul0004-0025" num="0107"><b>34</b> VELCRO-type closure holder </li><li id="ul0004-0026" num="0108"><b>35</b> guide strap </li><li id="ul0004-0027" num="0109"><b>36</b> pull-through strap </li><li id="ul0004-0028" num="0110"><b>37</b> sewed-on tab </li><li id="ul0004-0029" num="0111"><b>38</b> rounded corner </li><li id="ul0004-0030" num="0112"><b>40</b> lumbar spine corset </li><li id="ul0004-0031" num="0113"><b>41</b> corset supporting element </li><li id="ul0004-0032" num="0114"><b>42</b> cranial end of corset supporting element </li><li id="ul0004-0033" num="0115"><b>43</b> caudal end of corset supporting element </li><li id="ul0004-0034" num="0116"><b>44</b> recess in corset supporting element </li><li id="ul0004-0035" num="0117"><b>45</b> curve (around spine) in the corset supporting element </li><li id="ul0004-0036" num="0118"><b>46</b> receptacle area and/or passage </li><li id="ul0004-0037" num="0119"><b>47</b> curve-supporting clasp </li><li id="ul0004-0038" num="0120"><b>48</b> counter-coupling member </li><li id="ul0004-0039" num="0121"><b>50</b> spinal orthotic device </li><li id="ul0004-0040" num="0122"><b>60</b> thoracolumbar orthotic device </li><li id="ul0004-0041" num="0123"><b>110</b> sectional truss pad </li><li id="ul0004-0042" num="0124"><b>111</b> sections joined together with an articulation </li><li id="ul0004-0043" num="0125"><b>112</b> contact surface </li><li id="ul0004-0044" num="0126"><b>113</b> contacting insertion ends </li><li id="ul0004-0045" num="0127"><b>114</b> joints </li><li id="ul0004-0046" num="0128"><b>115</b> fixation element </li><li id="ul0004-0047" num="0129"><b>120</b> lower abdominal corset </li><li id="ul0004-0048" num="0130"><b>130</b> upper abdominal corset </li><li id="ul0004-0049" num="0131"><b>140</b> lumbar extension </li><li id="ul0004-0050" num="0132"><b>141</b> sections </li><li id="ul0004-0051" num="0133"><b>142</b> supporting rail </li><li id="ul0004-0052" num="0134"><b>150</b> contacting element </li><li id="ul0004-0053" num="0135"><b>151</b> recess </li><li id="ul0004-0054" num="0136"><b>152</b> fork-like receptacle </li><li id="ul0004-0055" num="0137"><b>160</b> supporting element </li><li id="ul0004-0056" num="0138"><b>161</b> securing clamp </li><li id="ul0004-0057" num="0139"><b>162</b> cranial end </li><li id="ul0004-0058" num="0140"><b>170</b> bridging frame </li><li id="ul0004-0059" num="0141"><b>171</b> half elements </li><li id="ul0004-0060" num="0142"><b>172</b> curved carriers </li><li id="ul0004-0061" num="0143"><b>173</b> connecting struts </li><li id="ul0004-0062" num="0144"><b>174</b> pockets </li><li id="ul0004-0063" num="0145"><b>180</b> reinforcing rods </li><li id="ul0004-0064" num="0146"><b>190</b> abdominal truss pad </li><li id="ul0004-0065" num="0147"><b>191</b> pressure plate </li><li id="ul0004-0066" num="0148"><b>192</b> VELCRO-type tape </li><li id="ul0004-0067" num="0149"><b>200</b> thoracic spinal corset </li><li id="ul0004-0068" num="0150"><b>201</b> pocket </li><li id="ul0004-0069" num="0151"> L<b>1</b> lumbar vertebra 1 </li><li id="ul0004-0070" num="0152"> L<b>2</b> lumbar vertebra 2 </li><li id="ul0004-0071" num="0153"> L<b>3</b> lumbar vertebra 3 </li><li id="ul0004-0072" num="0154"> L<b>4</b> lumbar vertebra 4 </li><li id="ul0004-0073" num="0155"> L<b>5</b> lumbar vertebra 5 </li><li id="ul0004-0074" num="0156"> S<b>1</b> first sacral vertebra </li></ul></li></ul>