Spinal Bracing

Thoraco-lumbo-sacral orthoses (TLSO)

Thoraco-lumbo-sacral orthoses (TLSOs) are utilized to address spinal pathologies from approximately the T6 to the L3–4 region. An over-shoulder overlap may allow control of the T4–5 levels, and a cervical extension addition to the TLSO is recommended for more definitive control above the T6 level. TLSOs most effectively control from approximately the sixth thoracic to the third and fourth lumbar vertebral region and offer diminishing control of spinal segments farther away from this region. Rigid immobilization is typically accomplished using a ‘body jacket’ made of plastic with a soft foam interface (lining). Soft, high-density body jackets can incorporate high-density outer foam instead of plastic. Plastic stays (permanent or removable) or a plastic frame can be incorporated into the foam for additional restriction of motion if desired. These systems, when custom fabricated, offer excellent alternatives to the rigid body jacket. They tend to be much better tolerated by the elderly patient and offer moderately effective restriction of spinal motion (Lusardi & Nielsen, 2000).

The TLSO corset (semiflexible) or off-the-shelf semi-rigid TLSO (i.e. Ossur, Aspen types) is often used for patients whose acceptance of a more rigid spinal orthosis is questionable or for patients who require minimal restriction of spinal motion. Compression fractures are very common in the geriatric population and frequently it is appropriate to manage them with these types of orthoses. Rigid systems such as the Jewett, Taylor and Knight-Taylor are less frequently used for the elderly because they are difficult to tolerate. Osteoporosis which commonly accompanies aging can result in kyphosis and related compression fractures. The Spinomed IV (www.mediusa.com) is a specialty TLSO designed to address this pathology optimally in combination with a coordinated physical therapy program.