What is the difference between a Thoracolumbosacral Orthosis (TLSO) brace and a Lumbosacral Orthosis (LSO) brace for spinal support?

Difference Between TLSO and LSO Braces for Spinal Support

The primary difference between a Thoracolumbosacral Orthosis (TLSO) and a Lumbosacral Orthosis (LSO) brace is the anatomical coverage area: TLSO braces extend higher to include thoracic vertebrae support, while LSO braces are limited to the lumbar and sacral regions.

Anatomical Coverage and Design

• A TLSO brace extends from the sacrum up to the thoracic region (typically to T7 or above), providing support and immobilization to the thoracic, lumbar, and sacral spine regions 1, 2
• An LSO brace covers only the lumbar and sacral regions, without extending to the thoracic spine, making it less restrictive to upper body movement 3
• TLSO braces are typically custom-fabricated from materials like polypropylene to ensure proper fit and effectiveness for the specific patient's anatomy 1, 2

Clinical Applications

• TLSO braces are indicated for:

  • Thoracic and thoracolumbar fractures requiring immobilization 4
  • Scoliosis with curves having an apical vertebra at T7 or below 1
  • Double major curves or when thoracic support is needed 3

• LSO braces are indicated for:

  • Isolated lumbar spine conditions or fractures 3
  • Single thoracolumbar or lumbar curves without significant thoracic involvement 3
  • Conditions where thoracic mobility is preferred or necessary 3

Effectiveness and Outcomes

• For thoracolumbar burst fractures, high-quality evidence shows that both external bracing (TLSO) and no bracing provide equivalent clinical outcomes in neurologically intact patients 4
• For adolescent idiopathic scoliosis with main thoracolumbar or lumbar curves, LSO demonstrates similar effectiveness to TLSO in treating the primary curves, but is less effective for thoracic curves 3
• Initial correction rates vary by curve location:
  • TLSO provides approximately 36% correction for thoracic curves, 56% for thoracolumbar curves, and 63% for lumbar curves 1
  • LSO is most effective for lumbar curves but less effective when thoracic curves exceed 21° 3

Motion Restriction and Comfort

• Research comparing different TLSO designs found no significant differences in motion restriction or passive trunk stiffness between various models 5
• Patient comfort can vary significantly between brace designs, with some TLSO models being rated more comfortable than others despite similar biomechanical effects 5
• LSO braces generally allow for greater thoracic mobility and may be more comfortable for patients who don't require thoracic support 3

Decision-Making Algorithm for Brace Selection

1. Determine the anatomical level of pathology:

   • If pathology involves thoracic spine (T7-T12): Select TLSO 1, 3
   • If pathology is limited to lumbar spine (L1-L5): Consider LSO 3

2. Evaluate curve characteristics (for scoliosis):

   • For thoracic curves >21°: TLSO is recommended 3
   • For isolated lumbar/thoracolumbar curves with minimal thoracic involvement (<21°): LSO may be sufficient 3

3. Consider patient factors:

   • For patients requiring maximum trunk immobilization: TLSO provides more comprehensive support 5
   • For patients where preserving thoracic mobility is important: LSO may be preferred 3

Important Clinical Considerations

• For thoracolumbar burst fractures in neurologically intact patients, evidence-based guidelines provide a grade B recommendation that management either with or without an external brace is acceptable, as both approaches show equivalent improvement in outcomes 4
• The decision to use an external brace should be at the treating physician's discretion, as bracing is not associated with increased adverse events compared to no brace 4
• For postoperative spinal fixation patients, some evidence suggests that those who used TLSO braces perceived significantly greater general health scores compared to those who did not use TLSO, though this must be balanced against potentially greater social limitations 6