A Thoracolumbosacral Orthosis (TLSO) is a rigid or semi-rigid medical device used to provide external support and stability to the spine. This back brace is prescribed to limit movement and promote healing in the mid and lower back regions. The TLSO helps maintain proper alignment and reduces stress on the vertebral column, acting as a temporary external skeleton.
What is a Thoracolumbosacral Orthosis (TLSO)?
The term Thoracolumbosacral Orthosis defines the large area of the body the brace encompasses, covering the thoracic (mid-back), lumbar (lower back), and sacral (pelvic) regions of the spine. TLSOs are typically constructed from rigid materials like molded thermoplastic or lightweight composites to ensure comprehensive support.
The primary mechanical action is achieved through a three-point pressure system. This system applies forces at specific points to counteract unwanted spinal motion, restricting forward, backward, side-to-side bending, and rotation.
The brace also functions by increasing intra-abdominal pressure, which reduces the vertical load on the intervertebral discs and vertebral bodies. This unloading mechanism stabilizes injured segments of the spine and aids in pain relief.
Custom vs. Prefabricated Designs
TLSOs are categorized into custom-molded and prefabricated (off-the-shelf) designs. Custom-molded braces are fabricated from a patient’s exact body contours, offering superior fit and control. Prefabricated options are adjusted from standardized sizes, providing a quicker solution.
Key Medical Conditions Treated by TLSOs
TLSOs are primarily prescribed for conditions requiring external stabilization or correction of the spinal column. One common indication is the conservative management of stable spinal fractures, such as vertebral compression fractures. The brace immobilizes the fracture site, reducing pain and allowing the bone to heal effectively. TLSOs are also frequently used for post-operative stabilization following surgical procedures like spinal fusion.
In managing spinal deformities, the TLSO plays a corrective or preventative role, most notably for adolescent idiopathic scoliosis. For growing children with moderate lateral spinal curves (25 to 45 degrees), bracing prevents the curve from progressing further. The brace applies corrective pressures to slow the abnormal growth of the spine until skeletal maturity is reached. TLSOs also manage severe kyphosis and provide support for pain associated with degenerative conditions like osteoporosis and herniated discs.
Understanding Different TLSO Designs
TLSO designs are specialized to achieve distinct biomechanical goals based on the patient’s condition. The Boston Brace is a low-profile, modular TLSO commonly prescribed for scoliosis. It applies corrective pressure pads to the convex side of the spinal curve, attempting to push the spine back toward the midline. To be effective in adolescents, this brace is worn full-time, often for 18 to 23 hours per day.
The Wilmington Brace is another full-contact design, custom-molded while the patient is lying down. It fully encloses the torso to provide continuous corrective pressure.
Hyperextension Braces
For spinal fractures, hyperextension braces are frequently used to limit forward bending and promote extension. Examples include the Jewett and the Cruciform Anterior Spinal Hyperextension (CASH) braces. These designs are characterized by a frame that applies pressure at three points:
- The sternum
- The pubic symphysis
- The middle of the back
These braces prevent the patient from flexing the spine, a movement that could worsen an anterior compression fracture. Other designs, like the two-piece clamshell or bivalve TLSO, provide maximum immobilization for unstable fractures or post-surgical recovery.
Practical Guide to Wearing and Caring for a TLSO
Properly wearing the TLSO is essential for its effectiveness. It typically involves donning the brace while lying down to ensure the spine is in the correct alignment. The brace must always be worn over a clean, close-fitting cotton garment, such as a T-shirt or tank top. This undergarment creates a necessary barrier between the skin and the plastic shell, helping to absorb sweat and prevent irritation. Straps and closures should be fastened snugly, without being painful, to maintain the necessary stabilizing pressure.
Skin care is an important daily maintenance routine while wearing a rigid brace. The skin underneath the brace should be inspected for redness, blistering, or breakdown every time the brace is removed. Lotions and powders should be avoided directly under the brace, as they trap moisture and make the skin vulnerable to irritation. The brace itself can be cleaned by wiping the inside with a damp cloth and mild soap or an alcohol solution. It must be completely dry before being put back on. Persistent red marks that do not fade within 20 to 30 minutes of removing the brace should be reported to the healthcare provider, as this indicates a fit adjustment is needed.