From the Guidelines
A Thoracolumbosacral Orthosis (TLSO) is not automatically required for a superior endplate fracture, as the decision to use a TLSO depends on fracture stability, location, and patient-specific factors. According to the American College of Radiology Appropriateness Criteria 1, the use of a TLSO is typically recommended for unstable fractures, those with significant vertebral body compression, or when pain control is challenging. For stable, non-displaced superior endplate fractures without neurological compromise, conservative management without bracing may be sufficient, as these types of fractures did not alter clinical management 1.
Key Considerations
- Fracture stability: Unstable fractures may require a TLSO to provide external support and limit spinal motion.
- Location: The location of the fracture can impact the decision to use a TLSO, with fractures in certain areas potentially requiring more aggressive treatment.
- Patient-specific factors: Pain level, functional status, and compliance ability are important considerations when deciding whether to use a TLSO.
- Imaging studies: Thorough clinical assessment, including imaging studies such as X-rays, CT, or MRI, is necessary to evaluate fracture characteristics and determine the best course of treatment 1.
Treatment Approach
- Treatment duration: Typically ranges from 6-12 weeks, with gradual weaning as healing progresses.
- Physical therapy: Often prescribed alongside bracing to prevent muscle atrophy and maintain strength.
- Follow-up imaging: Regular monitoring with follow-up imaging is necessary to assess healing progress and determine when bracing can be discontinued.
From the Research
Thoracolumbosacral Orthosis (TLSO) for Superior Endplate Fracture
- The use of a Thoracolumbosacral Orthosis (TLSO) for superior endplate fractures is a topic of debate, with various studies presenting different outcomes 2, 3, 4, 5, 6.
- Studies have compared the outcomes of patients with thoracolumbar burst fractures treated with and without a TLSO, with some finding no significant difference in pain and functional outcomes between the two groups 2, 3, 4.
- A study published in 2017 found that patients treated with a TLSO and those treated without a TLSO had similar outcomes at 5-10 years post-injury, with no significant difference in Roland Morris Disability Questionnaire (RMDQ) scores, kyphosis, or satisfaction 2.
- Another study published in 2014 found that patients treated with early ambulation and no orthosis had similar outcomes to those treated with a TLSO, with no significant difference in RMDQ scores at 3 months post-injury 3.
- A 2009 study found that patients treated with a TLSO and those treated without a TLSO had similar outcomes at 3 months post-injury, with no significant difference in RMDQ scores, pain, or functional outcome 4.
- A 2024 study found that patients who used a TLSO postoperatively had perceived significantly greater general health scores compared to those who did not use a TLSO, but also had lower satisfaction with their social limitations 5.
- A 2022 study found that patients who used a TLSO reported interference with their activities of daily living and would rather be without the brace if given the option, highlighting the need for a case-by-case approach to TLSO use 6.
Key Findings
- No significant difference in pain and functional outcomes between patients treated with and without a TLSO 2, 3, 4.
- TLSO use may not be necessary for all patients with thoracolumbar burst fractures 2, 3, 4.
- Patients who use a TLSO may experience interference with their activities of daily living and may not be satisfied with the brace 6.
- A case-by-case approach to TLSO use may be necessary to minimize costs and improve patient satisfaction 6.