From the Research
The recommended duration for wearing a TLSO (Thoracolumbosacral Orthosis) brace for a thoracic compression fracture is typically 3-6 months, with the most recent and highest quality study suggesting that rigid bracing may decrease pain up to 6 months post-injury 1.
Key Considerations
- The exact duration of bracing varies depending on several factors, including the severity of the fracture, the patient's age, bone density, overall health status, and healing progress as determined by follow-up imaging.
- Patients usually wear the brace for 23 hours per day during the initial period, with removal only for bathing and skin care.
- After this initial period, a gradual weaning process begins, where wearing time is reduced by 1-2 hours every few days as tolerated, based on pain levels and clinical improvement.
- The brace works by limiting spinal flexion and extension, which reduces pain and prevents further vertebral collapse while the fracture heals.
Additional Recommendations
- During the bracing period, patients should perform prescribed physical therapy exercises to maintain muscle strength and prevent deconditioning.
- Pain management typically includes NSAIDs, muscle relaxants, and occasionally short-term opioids for breakthrough pain.
- Older patients or those with osteoporosis may require longer bracing periods.
- It is essential to note that the use of a TLSO brace may not significantly affect radiographic parameters, opioid use, function, or quality of life at short- or long-term follow-up, as suggested by a recent systematic review and meta-analysis 1.
Evidence-Based Practice
- A study published in the Journal of Spine Surgery found that rigid bracing resulted in significantly less pain compared to no brace at 3 to 6 months post-injury, though this diminished at long-term follow-up of 48 weeks 1.
- Another study published in the Journal of Orthopaedic Trauma found that brace therapy scored significantly better on the Visual Analogue Scores for residual pain and on the Oswestry Disability Index compared to physical therapy and postural instructions alone 2.
- However, a more recent study published in Cureus suggested that 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 3.