Name of the Procedure:

Common name(s): Hyperextension TLSO brace, Jewett brace
Technical/medical term: TLSO, triplanar control, hyperextension, rigid anterior and lateral frame extends from symphysis pubis to sternal notch with two anterior components (one pubic and one sternal), posterior and lateral pads with straps and closures, limits spinal flexion (HCPCS L0472)

Summary

A Hyperextension TLSO brace is a type of thoraco-lumbo-sacral orthosis designed to limit spinal movement, particularly flexion (forward bending). It is a rigid support system extending from the pubic symphysis (lower front of pelvis) to the sternal notch (top of the sternum), aimed at stabilizing the spine and aiding in the healing of spinal fractures or post-surgical recovery.

Purpose

The primary purpose of this brace is to:

• Stabilize and immobilize the spine.
• Promote healing in spinal fractures or following spinal surgery.
• Limit spinal flexion to prevent further injury and alleviate pain.

Indications

• Compression fractures of the spine.
• Post-operative stabilization after spinal surgeries.
• Osteoporosis-related spinal conditions.
• Kyphosis and other spinal deformities requiring anterior and lateral spinal control.

Preparation

• No special fasting or medication adjustments are generally needed.
• A thorough physical examination and potentially imaging studies (X-ray or MRI) may be required to tailor the brace to the patient's specific needs.

Procedure Description

1. Measurement and Fitting: The patient is measured to ensure a proper fit.
2. Brace Application: The patient lies down or stands while the orthosis is carefully positioned.
3. Adjustment: The brace is adjusted to fit snugly, ensuring proper alignment and support with appropriate straps and closures.
4. Instruction: The patient is instructed on how to wear, remove, clean, and care for the brace.

The brace consists of:

• Rigid anterior and lateral frames.
• Anterior components at the pubic and sternal levels.
• Posterior and lateral support pads.
• Adjustable straps and closures.

Duration

Initial fitting and adjustment can take approximately 1 hour. The duration the brace must be worn varies based on the condition but usually ranges from several weeks to a few months.

Setting

The fitting and initial adjustment are typically performed in an orthopedics clinic or outpatient facility.

Personnel

• Orthotist or orthopedic specialist for fitting and adjustments.
• Occasionally, a physician may be involved in the initial assessment and treatment plan.

Risks and Complications

• Skin irritation or sores from prolonged wear.
• Discomfort or pain due to improper fit.
• Limited mobility leading to muscle weakness if used excessively.

Benefits

• Enhanced spinal stability and support.
• Reduced pain and risk of further injury.
• Improved healing post-surgery or after a fracture.

Patients might start experiencing benefits, such as pain relief and improved mobility, shortly after starting to wear the brace consistently.

Recovery

• Follow-up appointments are necessary to monitor fit and effectiveness.
• Daily skin checks for irritation.
• Gradual weaning off the brace as healing progresses, as advised by medical professionals.

Alternatives

• Soft lumbar braces or corsets.
• Physical therapy focusing on strengthening and stabilization exercises.
• Surgical interventions for severe cases, though they come with their own risks and recovery periods.

Patient Experience

Initially, wearing the brace may feel restrictive and uncomfortable. Patients may experience some pressure or irritation at contact points. Pain management includes over-the-counter pain relievers and regular adjustment checks to prevent discomfort. Adherence to wearing schedules and care instructions is crucial for the best outcome.