What is the typical duration of TLSO (Thoracolumbosacral Orthosis) use for a vertebral body fracture?

Duration of TLSO for Vertebral Body Fractures

Most vertebral body fractures require TLSO bracing for 6-8 weeks as the fracture typically heals during this period, after which the brace can be discontinued if pain has subsided and stability is confirmed. 1

Factors Affecting TLSO Duration

Standard Timeline

• Initial phase: 6-8 weeks of TLSO use for most uncomplicated vertebral body fractures 1
• Follow-up imaging at 6-8 weeks to assess healing and stability
• Extended use (up to 3 months) may be needed for:
  • Fractures at the thoracolumbar junction
  • Type A3 fractures (burst fractures)
  • Fractures with diffuse low-intensity areas on T2-weighted MRI 2

Evidence for Bracing Duration

• According to the Society of Neurointerventional Surgery, most acute back pain symptoms from vertebral fractures subside over 6-8 weeks as the fracture heals 1
• Studies show fracture settling (union) rates of:
  • 54.7% at 2 months
  • 79.2% at 3 months
  • 88.7% at 6 months 2

Efficacy of TLSO Bracing

Evidence on Bracing vs. No Bracing

• Level I evidence from randomized controlled trials shows no significant difference in outcomes between patients treated with or without TLSO bracing for neurologically intact thoracolumbar burst fractures 1
• Bailey et al. found no significant difference in disability scores (RMDQ), pain (VAS), quality of life (SF-36), patient satisfaction, or kyphosis at 3 months between braced and non-braced groups 1
• Shamji et al. similarly found no significant difference in pain, disability, or radiographic outcomes between treatment groups 1

Clinical Decision Making

Despite equivalent outcomes between bracing and no bracing, the decision to use TLSO remains at the physician's discretion based on:

1. Fracture characteristics:

   • Location (thoracolumbar junction fractures may benefit more from bracing)
   • Type (burst vs. compression)
   • Severity of vertebral height loss

2. Patient factors:

   • Age (older patients may have longer healing times) 2
   • Bone quality (severe osteoporosis may require longer bracing)
   • Compliance with activity restrictions
   • Comorbidities affecting healing

Practical Considerations

Monitoring and Follow-up

• Clinical assessment at 2-3 weeks to evaluate pain and compliance
• Radiographic follow-up at 6-8 weeks to assess healing
• Additional follow-up at 3 months if not fully healed at initial follow-up
• Consider weaning from brace rather than abrupt discontinuation

Common Pitfalls

• Patient non-compliance: 73% of patients stop using the brace earlier than advised 3
• Prolonged bracing can lead to:
  • Decreased lung capacity
  • Skin breakdown
  • Paraspinal muscle atrophy 3
  • Increased hospital length of stay (average 3 days longer) 3

Special Considerations

• For patients with persistent pain after 3 months of conservative treatment, vertebral augmentation procedures (vertebroplasty or kyphoplasty) may be considered 1
• Patients with lower extremity fractures in addition to vertebral fractures require more physical therapy sessions to achieve independent ambulation 4

In summary, while the standard duration for TLSO use is 6-8 weeks, the decision should be guided by clinical and radiographic evidence of fracture healing, with consideration of patient-specific factors that may influence healing time.