Name of the Procedure:

Lumbar-Sacral Orthosis (LSO), Sagittal-Coronal Control with Rigid Frame (HCPCS L0650)

Summary

A lumbar-sacral orthosis (LSO) is a medical back brace designed to stabilize and support the lower back and sacral region. This specific type of orthosis includes rigid anterior and posterior panels as well as lateral support to control movement in the sagittal (front-to-back) and coronal (side-to-side) planes, providing comprehensive spinal stabilization.

Purpose

The LSO with sagittal-coronal control helps manage conditions affecting the lumbar and sacral spine by:

• Stabilizing and immobilizing the spine to aid healing
• Reducing pain by limiting spinal motion
• Providing support to decrease the load on the spine during activity

Indications

This orthosis is indicated for patients with:

• Spinal fractures or injuries in the lumbar and sacral regions
• Post-surgical stabilization needs
• Chronic lower back pain due to degenerative conditions like lumbar spinal stenosis or spondylolisthesis
• Spinal deformities requiring correction

Preparation

Patients may need to:

• Undergo diagnostic imaging like X-rays, MRI, or CT scans to determine the appropriate orthosis type
• Consult with their healthcare team to adjust any medications, especially blood thinners, before surgical orthosis placement

Procedure Description

1. Assessment: The healthcare provider assesses the patient's spinal condition and measures the body for a correctly fitting orthosis.
2. Fitting: The patient is fitted with the LSO, which includes rigid panels that extend from the sacrococcygeal junction to the T-9 vertebra.
3. Adjustment: Straps and fasteners are adjusted to ensure the orthosis fits snugly and provides the needed support without causing discomfort.
4. Instruction: The patient is instructed on how to wear, adjust, and care for the orthosis. Depending on the case, the healthcare provider may guide how to position the body while wearing the brace.

No anesthesia or sedation is generally required for this procedure.

Duration

The fitting procedure usually takes about 30 minutes to 1 hour.

Setting

The fitting and adjustment of the LSO can be done in an outpatient clinic or an orthotics and prosthetics center.

Personnel

• Orthotist: Specializes in designing and fitting orthotic devices
• Physician: Oversees the patient’s overall care and provides medical evaluation and guidance
• Nurse or Medical Assistant: May assist in the fitting and provide patient education

Risks and Complications

• Common Risks: Discomfort or irritation from the brace, skin breakdown, muscle atrophy if used long-term without proper physical therapy
• Rare Risks: Nerve compression or circulation issues due to improper fit

Benefits

• Pain Relief: Reduction in back pain through stabilization
• Healing Promotion: Ensures proper alignment and immobilization to support healing post-surgery or injury
• Activity Support: Helps patients perform daily activities with less pain and risk of further injury

Recovery

• Patients are usually instructed to wear the brace for a specified period, ranging from weeks to months, depending on their condition and healing progress.
• Follow-up appointments will ensure the brace fits well and adjustments are made as needed.
• Physical therapy may be recommended to strengthen muscles and improve spine health as the patient recovers.

Alternatives

• Conservative Treatments: Physical therapy, pain management with medication, and lifestyle modifications.
• Surgical Options: If spinal instability is severe, surgical intervention such as spinal fusion might be considered.
• Other Orthoses: Softer, less restrictive braces for milder conditions.

Patient Experience

• During the Procedure: Discomfort during initial fitting, but not painful.
• After the Procedure: Patients may experience relief from pain and improved function. Some may find the brace cumbersome initially but should adapt with proper guidance.
• Pain Management: Temporary discomfort can be managed with over-the-counter pain relievers or adjustments in the brace fit. Regular follow-ups ensure optimal comfort and function.