From the Research
A Thoracolumbosacral Orthosis (TLSO) is generally not indicated for chronic vertebral compression fractures. For most patients with chronic compression fractures, bracing with a TLSO provides limited benefit once the acute pain phase has passed (typically 6-12 weeks after fracture) 1. Instead, treatment should focus on pain management with appropriate analgesics (acetaminophen, NSAIDs if not contraindicated, or low-dose opioids for breakthrough pain), physical therapy to strengthen core and back muscles, and weight-bearing exercises to improve bone density.
Some key points to consider in the management of chronic vertebral compression fractures include:
- The use of TLSOs is more appropriate for acute vertebral compression fractures, where they can provide temporary immobilization, pain relief, and postural support during the healing phase 2.
- In chronic cases, prolonged bracing may actually lead to muscle deconditioning, increased bone loss, and dependency 1.
- Some exceptions exist where a TLSO might be considered in chronic cases, such as in patients with significant ongoing pain despite conservative measures, multiple adjacent fractures causing instability, or in those who cannot tolerate other treatments 3.
- The decision should be individualized based on the patient's specific clinical situation, pain level, functional status, and bone quality 1.
It's also important to note that the most recent and highest quality study available should guide clinical decision-making. In this case, the study by 1 provides the most relevant and up-to-date information on the use of TLSOs in the management of vertebral compression fractures.
Overall, the management of chronic vertebral compression fractures requires a comprehensive approach that takes into account the patient's overall health, functional status, and quality of life. While TLSOs may have a limited role in the management of chronic vertebral compression fractures, they can be a useful tool in the acute phase of treatment.