From the Guidelines
A thoracolumbosacral orthosis (TLSO) is the recommended brace for patients requiring spinal support from the thoracic to sacral regions. This recommendation is based on the principle of early immobilization of the spine to limit the onset or aggravation of neurological deficit, as suggested by the French recommendations for the management of patients with spinal cord injury or at risk of spinal cord injury 1. The TLSO provides stabilization and immobilization of the thoracic and lumbar spine, which is essential for promoting healing and proper alignment in conditions such as thoracolumbar fractures, post-surgical stabilization, scoliosis management, or spinal deformities.
- Key features of a TLSO include:
- Rigid design that extends from just below the shoulders down to the sacrum
- Limitation of spinal motion to reduce axial loading and provide external support
- Custom-molded or carefully sized by an orthotist for proper fitting
- Patient instructions for wearing a TLSO typically include:
- Wearing the brace 23 hours per day initially, with gradual weaning as healing progresses
- Wearing a thin, cotton shirt underneath to prevent skin irritation
- Performing regular skin checks for pressure areas
- Avoiding bending, twisting, or lifting heavy objects
- Following specific donning and doffing instructions provided by the healthcare team 1.
From the Research
Types of Braces for Spinal Support
- A Thoracolumbosacral Orthosis (TLSO) is a type of brace that provides spinal support and stabilization for patients with thoracolumbar spine fractures or scoliosis 2, 3, 4, 5, 6.
- TLSO braces are designed to correct, adjust, or modify the operation of the thoracic and lumbar spine, and are commonly used for patients who require back correction and/or support 4.
Efficacy of TLSO Braces
- The efficacy of TLSO bracing remains controversial, with several studies showing that prolonged brace use is associated with diminished lung capacity, skin breakdown, and paraspinal muscular atrophy, with no significant difference in pain and functional outcomes between patients treated with or without TLSO 2.
- However, other studies have found that TLSO treatment can correct both thoracic and lumbar scoliosis, reduce lateral trunk shift, and stop progression of scoliosis, although it may have no effect on the droop of the lower ribs 3.
Comparison of TLSO and No Orthosis
- A multicenter randomized clinical equivalence trial compared the outcome of patients with thoracolumbar burst fractures treated with and without a TLSO, and found no significant difference between treatment groups for any outcome measure at any stage in the follow-up period 5, 6.
- The study suggested that patients treated with early mobilization without orthosis maintain similar pain relief and improvement in function for 5-10 years, compared to patients treated with a TLSO 5.
Patient Satisfaction and Outcomes
- A study found that 60% of patients reported not receiving adequate advice regarding the duration of treatment, 43% reported that the brace interfered with their activities of daily living, and 73% came off the brace earlier than advised 2.
- The study also found that 60% of patients reported that they would rather be without the brace if given the option, highlighting the need for a case-by-case, patient-centered approach to minimize costs and improve patient satisfaction 2.