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A TLSO, or thoracolumbosacral orthosis, is a type of back brace used to limit motion and promote healing in the thoracic, lumbar, and sacral regions of the spine. It’s typically prescribed after surgery or for stable middle and lower back fractures and can also be used to correct lateral scoliotic curves. Proper use of the TLSO can help the patient maintain proper alignment and mobility during recovery.

Using a TLSO Brace

Bracing is based on the idea that increased weight on a particular area of a growing spine can inhibit its growth. A TLSO brace utilizes specialized pads placed in certain areas to apply pressure on abnormal curves, which helps slow their growth.

By controlling the progression and keeping the Cobb angle below 40 degrees, a patient may be able to avoid surgical interventions such as spinal fusion.

Typically, bracing is limited to the pediatric population as it’s most effective for growing spines. Children between the ages of 12 and 15 with Cobb angles ranging from 20 to 40 degrees are often prescribed TLSO braces, typically pre-fabricated in a corset style using rigid plastic and available in small, medium, or large sizes.

In the US, the Boston brace is the most commonly used design. For bracing to be effective, the child is required to wear the brace for a minimum of 18 to 23 hours per day. The recommended duration of bracing is three to five years.

While wearing a TLSO brace underneath loose clothing is feasible, many adolescents may hesitate to wear one that restricts their movements throughout the day. The effectiveness of the brace heavily relies on consistent and prolonged usage.

Unfortunately, many teenagers choose to remove their braces as soon as they arrive at school, resulting in a substantial decrease in the success rate of the treatment.

How To Wear A TLSO Brace

If you’ve been prescribed a TLSO, brace for an injury or medical condition, it’s important to know how to wear it properly. A TLSO brace is designed to provide support and stability to your thoracic, lumbar, and sacral spine areas.

By following some simple steps, you can ensure that the brace effectively manages your condition or injury and is comfortable to wear throughout the day.

Here are some key tips on how to wear a TLSO brace correctly:

  • While lying flat on a bed, roll to one side without twisting.
  • Position the back piece of the brace under your back, ensuring that the pelvic indentation or groove lines up with the edge of your pelvic or hip bone.
  • Roll onto your back and check that the brace is in the correct position with the hip indentation in place and the brace centered and at equal heights on both sides of your body. If not, adjust the brace by rolling to the opposite side and repositioning it correctly.
  • Attach the abdominal strap.
  • Place the front piece of the brace on top, ensuring that it overlaps the bottom piece.
  • Thread all six sides of Velcro straps through the metal loops, starting with the bottom two, then the middle two, and finally, the top two, tightening them evenly to achieve a snug fit.
  • Bring the two shoulder straps over your shoulders and thread them through the top metal loops, fastening them securely.
  • You may now get out of bed.
  • If the brace is uncomfortable or not fitting correctly, do not attempt to adjust it yourself. Contact the Orthotist who fitted you for the brace.
  • Wear the brace at all times while sitting or standing, but it can be removed while lying down.

How to Remove Your TLSO Brace

Removing a TLSO brace properly is important to prevent further injury or discomfort and ensure that the brace continues functioning as intended.

Here are the steps on how to remove your TLSO brace safely and comfortably:​

  1. Lie flat on your back.
  2. Unfasten the Velcro straps.
  3. Remove the front section of the brace first.
  4. Roll like a log onto the side that’s most comfortable for you.
  5. Slide out the back section of the brace.

General Tips for Using TLSO Brace

Following some basic guidelines, you can prevent skin irritation and achieve the best possible results from your brace.

Here are some key points to remember when wearing a brace, including tips on how to safely apply it, how frequently to wear it, and how to check for signs of skin irritation.

  • To prevent skin irritation and absorb sweat, wearing a T-shirt underneath the brace is recommended.
  • Follow the doctor’s instructions on how frequently and for how long you should wear the brace each day. Unless otherwise directed, 
  • It’s not necessary to wear the brace while sleeping.
  • If needed, ask your doctor for a specialized brace to wear while showering.
  • Safely apply the brace as demonstrated in the hospital, and seek assistance if necessary.
  • Regularly check for signs of skin irritation or redness caused by the brace. Consider adjusting the brace or consulting your doctor for a different size if these occur.
  • To feel more comfortable and absorb sweat, consider wearing a singlet or a tight-fitting top under the brace.
  • Ensure all straps are tightened as much as possible. The shoulder straps should keep your shoulders back to prevent gaps between your back and the top part of the brace.
  • Avoid lifting objects heavier than 2kg.
  • If you notice redness on your skin, do not apply padding, as it could worsen the pressure. Instead, seek help from your Orthotist.

Disadvantages of Bracing

To wear a brace for up to five years without the ability to bend the torso makes breathing difficult and exercise impossible. While wearing the brace, activities like dancing, sports, and even simple movements become a challenge.

The physical discomfort is compounded by the psychological harm of teasing and peer stares. Some teenagers feel that the risk of spinal surgery is not worth enduring the challenges associated with wearing a brace.

While a brace can prevent scoliosis from worsening, it doesn’t correct the Cobb angle, meaning that misalignment is still present after removing the brace.

That can cause scoliosis to wear out the discs in the spine more quickly, resulting in an increased Cobb angle. Although wearing a brace has a 75% success rate in preventing surgery, one in every four patients will still require surgery.

A Cobb angle of 30 degrees is often the tipping point for whether or not scoliosis progresses to surgery in adulthood, with a high chance that it’ll increase at least 10 degrees over time. Doctors may consider surgery for patients with 40-degree Cobb angles or higher.
While a brace can prevent surgery during the teenage years, as the teenager ages, the spine may deteriorate, potentially making surgery necessary despite the brace being considered “successful.”

Making the Best Decision for Your Scoliosis Treatment

TLSO Braces can significantly reduce spinal pain, improve posture and help maintain an active lifestyle. With the correct information, you can decide about your treatment options.

At Align Clinic, we help you select the right TLSO Brace for your needs. Call us today and we’ll guide you toward the best solution to your spinal condition.