A Thoraco-Lumbo-Sacral Orthosis, or TLSO, is a rigid device designed to stabilize the mid and lower regions of the spine. The TLSO acronym stands for the three major spinal areas the brace encompasses: the thoracic, lumbar, and sacral spine. It functions essentially as a removable body cast, restricting movements that could interfere with recovery.
Understanding the TLSO Structure and Mechanism
The TLSO is constructed from rigid materials, most commonly molded thermoplastic or lightweight composites, and is often custom-fitted to the individual’s unique body contours. It typically consists of a front panel and a back panel, which are secured together with straps, creating a shell around the patient’s torso. The inside of the brace usually features comfortable foam lining and breathable fabric to protect the skin.
This design works biomechanically by limiting motion in all three planes: restricting forward bending (flexion), backward bending (extension), lateral bending, and spinal rotation. The brace achieves this high degree of stabilization through a principle known as the three-point pressure system. This system involves applying forces at three specific points to control or correct spinal position.
In a typical spinal immobilization TLSO, two forces are applied in one direction, often at the front of the body, with an equal and opposite force applied at a single point on the back. For example, in a hyperextension orthosis, two posteriorly directed forces—one at the sternal pad and one at the suprapubic pad—are counteracted by an anteriorly directed force at the lumbar pad. This mechanism effectively reduces the load on vertebral bodies and intervertebral discs by increasing intra-abdominal pressure and maintaining postural alignment.
For conditions like scoliosis, the three-point pressure system is used differently, applying forces to the convex side of the spinal curve to push it toward the midline and reduce the curve’s progression. The intimate fit of the custom-molded brace is necessary to ensure these corrective or stabilizing forces are applied effectively.
Common Conditions Requiring a TLSO Brace
The TLSO is prescribed for a range of spinal conditions where motion control is necessary to facilitate recovery or prevent deformity progression. One primary indication is the non-operative management of stable thoracolumbar spinal fractures, such as certain compression fractures caused by trauma or osteoporosis. The brace immobilizes the area to prevent micro-movements that could worsen the injury or delay bone healing.
Post-operative support is another frequent use, as the brace helps to maintain the corrections achieved during spinal fusion surgery. By limiting movement during the critical healing period, the TLSO reduces stress on the surgical site and supports the integration of bone grafts.
In the pediatric population, the TLSO is a common treatment for managing adolescent idiopathic scoliosis, which is a sideways curvature of the spine. The brace is most effective for growing children with Cobb angles typically ranging from 20 to 40 degrees. The external pressure applied by the brace aims to prevent the curve from progressing further, sometimes avoiding the need for surgical intervention. Other conditions like kyphosis, degenerative disc disease, and spinal stenosis may also benefit from the stability and pain relief provided by a TLSO.
Practical Guide to Wearing and Care
Proper application and removal of the TLSO, known as donning and doffing, must often be performed while lying down to ensure the spine remains stable. The brace should be worn over a clean, tight-fitting cotton garment, such as a tank top, which acts as a protective barrier and absorbs sweat. This undergarment should be wrinkle-free, as wrinkles can create pressure points leading to skin irritation.
The brace must be worn tightly and snugly for it to function correctly, with the straps fastened to the marks indicated by the orthotist. A common sign that the brace is too loose is if it “rides up” on the patient, requiring them to lie down, reposition it over the waist groove, and tighten the straps again. Patients must adhere strictly to the prescribed wearing schedule, which for some spinal fractures or post-operative cases may be nearly full-time, while scoliosis treatment often requires 18 to 22 hours per day.
Diligent skin care is a high priority to prevent breakdown beneath the rigid plastic shell. The skin under the brace should be cleaned regularly with a mild soap or damp cloth and then thoroughly dried. Lotions, creams, and powders must be avoided directly under the brace, as they can soften the skin, making it more susceptible to friction and irritation.
The brace itself requires regular cleaning, which can be done by wiping the inside and outside with a damp cloth and mild soap or rubbing alcohol. It is essential to ensure the brace is completely dry before putting it back on, especially the foam lining. Patients should immediately contact their healthcare provider or orthotist if they notice:
- Persistent redness lasting longer than 20 to 30 minutes after removal.
- Blistering.
- New or increased pain.
- If the brace becomes damaged.