Name of the Procedure:

Thoracolumbosacral Orthosis (TLSO)
Common names: Back brace, Spinal orthosis
Technical term: Tlso, sagittal-coronal control, one piece rigid plastic shell, with overlapping reinforced anterior, with multiple straps and closures.

Summary

A TLSO is a type of back brace that stabilizes and supports the thoracic, lumbar, and sacral regions of the spine. Made from rigid plastic, it covers from the sacrococcygeal junction to the T9 vertebra at the back and from the sacrum to the sternum in the front, providing substantial support with multiple straps and closures ensuring a secure fit.

Purpose

The primary purpose of a TLSO is to treat spinal conditions that require immobilization or alignment correction. These conditions often include fractures, scoliosis, post-operative spine recovery, and other spinal deformities. The brace provides stability to aid in the healing process, reduce pain, and prevent further injury.

Indications

• Vertebral fractures
• Scoliosis
• Post-operative support following spinal surgery
• Spinal deformities
• Degenerative spinal conditions
• Patients requiring immobilization for spinal stability

Preparation

Patients may need to:

• Undergo a physical examination and imaging studies (e.g., X-rays, MRI) to determine the exact nature of the spinal condition.
• Receive instructions on how to wear and adjust the TLSO properly.
• Potentially adjust medications or activities as advised by their healthcare provider.

Procedure Description

1. Measurement and Fitting:

   • The patient is measured to ensure the correct size of the TLSO.
   • Adjustments are made to the brace for proper fit.

2. Application:

   • The patient is instructed to either lie down or stand while the brace is applied.
   • The brace is positioned on the patient’s torso, covering the necessary spinal regions.
   • Multiple straps and closures are adjusted to secure a snug fit.

3. Patient Instruction:

   • The patient is shown how to put on, take off, and adjust the TLSO independently.
   • Care and cleaning instructions for the brace are provided.

Duration

The fitting and instruction process typically takes around 30 to 60 minutes. The duration for which the brace must be worn can vary significantly based on the medical condition, usually ranging from a few weeks to several months.

Setting

The procedure is usually performed in an outpatient clinic, orthotics clinic, or a hospital setting.

Personnel

• Orthotist (specialist in braces and supports)
• Healthcare provider (e.g., orthopedic surgeon, neurologist)
• Nurses or medical assistants for support and instruction

Risks and Complications

• Skin irritation or pressure sores from brace friction
• Discomfort or improper fit
• Reduced mobility
• Muscle atrophy from prolonged use
• Non-compliance due to discomfort or inconvenience

Benefits

• Provides necessary spinal support to promote healing
• Reduces pain and discomfort from spinal instability
• Prevents further injury or worsening of the condition
• Corrects or maintains proper spinal alignment

Recovery

• Regular follow-up appointments to monitor progress and adjust the brace as needed.
• Patients can usually resume most daily activities with the brace on, but might need to avoid strenuous activities.
• Skin care routines to prevent irritation.
• Gradual weaning off the brace as per medical advice.

Alternatives

• Soft braces or corsets (providing less support)
• Physical therapy
• Surgery (for more severe conditions)
• Medication management

Pros of TLSO:

• Non-invasive
• Immediate support

Cons of TLSO:

• Can be uncomfortable
• Requires patient compliance

Patient Experience

• Initial discomfort as the patient adjusts to wearing the brace.
• Some limitations in movement and flexibility.
• Potential skin irritation which can be managed with pads or liners.
• Over time, patients often experience reduced pain and improved stability. Pain management can include over-the-counter pain relievers if required. Comfort can be enhanced by wearing a thin layer of clothing beneath the brace.