Name of the Procedure:

Thoracolumbosacral Orthosis (TLSO) with Sagittal-Coronal Control, also known as a modular segmented spinal system with two rigid plastic shells. Medical code: L0491.

Summary

A TLSO with sagittal-coronal control is a type of back brace designed to immobilize and support the spine. It consists of two rigid plastic shells that encase the torso, extending from the lower back (sacrococcygeal junction) up to just below the shoulder blades (scapular spine) in the back, and from the pubic bone (symphysis pubis) to the lower sternum (xiphoid) in the front. This specialized brace helps manage spinal conditions by limiting movement and providing stability.

Purpose

The TLSO with sagittal-coronal control is used to treat various spinal conditions, such as fractures, post-surgical recovery, and scoliosis. The primary goals are to stabilize the spine, reduce pain, prevent further injury or deformity, and promote healing.

Indications

• Spinal fractures affecting the thoracic or lumbar regions
• Post-operative care following spinal surgery
• Management of scoliosis
• Conditions requiring spinal immobilization and support
• Severe cases of spinal deformities

Preparation

• No special dietary restrictions or fasting required.
• The patient may need a physical examination and imaging tests, such as X-rays or MRI, to assess the spine's condition and determine the appropriate fit for the brace.

Procedure Description

1. Measurement and Fitting: The healthcare professional will take precise measurements of the patient’s torso to ensure a custom fit.
2. Casting (if needed): For some cases, a mold or cast of the torso might be created to fabricate the brace.
3. Brace Fabrication: The custom TLSO is then fabricated based on the measurements or mold.
4. Fitting and Adjustment: The patient will try on the brace, and any necessary adjustments will be made to ensure proper fit and comfort.
5. Instructions: The patient will receive detailed instructions on how to wear, adjust, and care for the brace.

Tools and technology include measurement tools, casting materials, and fabrication equipment.

Duration

The entire process from measurement to the final fitting can take several hours to days, but the actual fitting session typically takes about 1-2 hours.

Setting

The procedure is usually performed in an orthotics or prosthetics clinic, or a specialized department within a hospital.

Personnel

• Orthotist or Prosthetist
• Nurse or medical assistant
• Occasionally, a physician or orthopedic surgeon

Risks and Complications

• Skin irritation or sores from the brace
• Discomfort or pain due to improper fit
• Difficulty in breathing if the brace is too tight
• Muscle weakness from prolonged immobilization

Benefits

• Stabilization and support of the spine
• Pain relief
• Prevention of further spinal injury or deformity
• Promotion of healing in cases of fractures or post-surgery

Recovery

• Follow the specific wear schedule prescribed by the healthcare provider.
• Monitor the fit and comfort of the brace, and report any issues to the orthotist.
• Wear the brace as directed, typically for several weeks to months, depending on the condition.
• Attend follow-up appointments for adjustments and monitoring progress.

Alternatives

• Other types of spinal braces or supports
• Physical therapy
• Surgery in severe cases
• Medication for pain and inflammation

Each alternative has its own set of pros and cons, which should be discussed with a healthcare provider.

Patient Experience

• Initial adjustment to wearing the brace may include discomfort or restricted movement.
• The brace should become more comfortable with time as the patient adapts.
• Pain management strategies, such as over-the-counter pain relievers or prescribed medications, may be utilized.
• The patient may require assistance with activities of daily living initially.

It is essential to follow all medical advice and instructions to ensure the best possible outcome.