HCPCS Procedure: TLso Flexible (L0454)

Name of the Procedure:

• Common Name: Thoracolumbosacral Orthosis (TLSO)
• Technical Term: TLso Flexible, Trunk Support Orthosis

Summary

A TLso Flexible is a medical device worn around the torso to provide support to the trunk and restrict excessive motion. It extends from just above the tailbone to above the T9 vertebra in the mid-back. It helps stabilize the spine and reduce the load on the intervertebral disks through increased intracavitary pressure.

Purpose

• Medical Conditions Addressed: Spinal instability, herniated disks, post-operative recovery, chronic back pain.
• Goals/Outcomes: Stabilize the spine, reduce pain, prevent further injury, and hasten recovery by restricting motion and reducing stress on spinal disks.

Indications

• Specific Symptoms/Conditions: Chronic back pain, spinal instability, spondylolisthesis, intervertebral disk herniation, post-spinal surgery recovery.
• Patient Criteria: Patients experiencing significant trunk instability or who require spinal support and motion restriction in the sagittal plane.

Preparation

• Pre-Procedural Instructions: No specific fasting or medication adjustments required. Patients might be advised to wear loose-fitting clothing.
• Diagnostic Tests: X-rays, MRI, or other imaging studies to assess the spine condition and determine the need for the orthosis.

Procedure Description

1. Assessment: A healthcare provider evaluates the patient's condition and spinal alignment.
2. Fitting: The orthosis is custom-fitted to the patient’s body. Adjustments are made to ensure proper support and comfort.
3. Usage Instructions: Patients are instructed on how to wear and fasten the device correctly.
4. Follow-up: Regular follow-up appointments to monitor progress and make any necessary adjustments.

• Tools/Equipment: Custom-fabricated orthosis, measuring tools, adjustment straps, and fasteners.
• Anesthesia/Sedation: Not required.

Duration

• The initial fitting appointment typically takes about 1 to 2 hours.
• Wearing duration depends on the specific medical condition and doctor’s recommendation, ranging from a few hours daily to full-day use.

Setting

• The procedure is performed in an outpatient clinic or a specialized orthotics department.

Personnel

• Healthcare Professionals: Orthotists, physiatrists, trained medical technicians.

Risks and Complications

• Common Risks: Skin irritation, discomfort, muscle weakness due to prolonged use.
• Rare Risks: Pressure sores, restricted blood flow, allergic reaction to materials.
• Management: Regular monitoring, adjustments to the device, proper skin care, and maintaining muscle strength through exercises.

Benefits

• Expected Benefits: Improved spinal stability, reduced pain, prevention of further spine injury, enhanced recovery post-surgery.
• Realization Time: Benefits may be noticed immediately upon proper fitting and continued with consistent use.

Recovery

• Post-Procedure Care: Patients should follow the wear schedule prescribed by their healthcare provider, care for the orthosis, and monitor skin condition.
• Recovery Time: Varies based on the individual condition; complete recovery and weaning off the orthosis may take weeks to several months.
• Restrictions/Follow-up: Regular follow-up appointments to adjust the orthosis and assess recovery progress.

Alternatives

• Other Treatment Options: Physical therapy, medication for pain management, other types of back braces, surgical interventions.
• Pros and Cons: Physical therapy can help strengthen muscles but may take longer to see results. Surgery offers a more permanent solution but comes with higher risks and longer recovery times.

Patient Experience

• During Procedure: Minimal discomfort during fitting; no pain.
• After Procedure: May experience initial discomfort, skin irritation, and need for adjustment. Pain can be managed through regular monitoring, adjustments, and prescribed skin care routines.
• Pain Management: Over-the-counter pain relief if needed, and keeping in touch with healthcare providers for any concerns.