TLSO brace Posted in: Treatment

TLSO is an acronym for thoracolumbosacral orthosis, a brace for the mid to lower spine.  Although a bit of a mouthful, we’re talking about the main type of brace used to correct a sideways, or lateral, scoliotic curve in the mid to lower spine.

Using a TLSO Brace

The theory behind bracing is that, in a growing spine, if more weight is pushing down on one area, then that area will grow more slowly. In a TLSO brace, strategically placed pads put pressure on the unnatural curves to slow down their growth. If the progression is slowed and the Cobb angle does not exceed the surgical level of 40 degrees, then the person wearing the brace is able to avoid spinal fusion surgery.

Bracing is generally only prescribed to children, because it’s only effective for growing spines. Teens 12 to 15 years old with Cobb angles of 20 to 40 degrees wear braces for three to five years. TLSO braces are corset style, usually pre-made out of rigid plastic in sizes small, medium, or large. The most common TLSO brace design in the U.S. is the Boston brace. To be effective, the child must wear the brace 18-23 hours a day.

It’s possible to wear a TLSO brace underneath your clothes, if they are baggy enough to accommodate it. The problem with this is that many teenagers don’t want to wear a motion-restricting brace around all day. And if it’s not worn all day, the brace’s success rate drops substantially. Often, teens arrive at school, and the brace goes straight into the locker.

Disadvantages to Bracing

Without the flexibility to bend the torso, breathing is restricted and exercise is difficult, if not impossible. You can’t dance, play sports, or move easily while wearing a brace. And this goes on for up to five years of your life. Aside from the physical discomfort, many teenagers feel that the psychological harm from teasing and stares from peers is simply not worth lowering the risk of spinal surgery.

Aggressive scoliosis can still progress to surgical levels despite wearing a brace for five years. There is a 75% chance that the brace will work well enough to prevent surgery, which sounds great at first glance. But in practice, that means for every four patients wearing a brace, one will still require surgery.

Since a brace doesn’t correct the Cobb angle, but only stops it from getting worse, that same misalignment is still there after you take off the brace. Think of it like the alignment in your car. If the alignment is off, the tires wear down more quickly. Since the misalignment in your spine was not corrected by the brace, the scoliosis wears out the discs in your spine more quickly, causing your Cobb angle to increase.

A Cobb angle of 30 degrees is often the tipping point for whether or not the scoliosis progresses to a surgical level in adulthood. There is a good chance that a 30-degree Cobb angle will increase at least 10 degrees over a period of years. And doctors begin considering surgery for patients with 40-degree Cobb angles or higher. The brace may stop surgery as a teenager, but, as that teenager gets older, time takes its toll on the spine. Surgery could still be necessary even though the brace was technically “successful” through their teenage years.

Alternative Treatments to Bracing

Although the traditional approach calls for observation, bracing and then surgery, these aren’t your only options. There’s still hope even if you’re not interested in spending half your teenage years in the confines of a brace. Alternative treatments, like the CLEAR approach, can use scoliosis-specific exercises, adjustments and other therapies to stabilize and actually correct the Cobb angle. No brace required.

In fact, the TLSO brace actually takes the fundamentally opposite approach that we think is beneficial for people with scoliosis. Braces restrict and weaken the spine in an effort to prevent the Cobb angle from worsening. By contrast, the CLEAR approach works to strengthen and rehabilitate it so that it can regain its natural position and function.

Braces zero in on the Cobb angle measurement to determine success or failure. However, a decreased Cobb angle doesn’t necessarily correct common ailments associated with scoliosis, such as trouble breathing, hunched appearance, and back pain. Taking a more holistic approach to scoliosis treatment can achieve these lifestyle improvements. It all comes down to what’s important to you.

Bracing isn’t for everyone. It’s important to discuss options with your doctor and ask about alternatives. Something like the CLEAR treatment may be a viable alternative to avoid spinal fusion surgery in your particular situation.

What do you think about the TLSO brace? Have you worn one? Or tried an alternative treatment that you’ve loved? We’d love to hear from you in the comments below.

18 comments on “What is a TLSO Brace?”

  1. 1
    Aaron on July 21, 2016

    Awesome article what other scoliosis brace’s are on the market besides the Boston? If there was brace that was more fashionable maybe teenagers would be more inclined to wear it throughout the day.

    1. 2
      Dr. Josh Woggon on July 22, 2016

      Thank you very much! Here is an article which does a great job of summarizing many of the different types of scoliosis braces from around the world:
      http://tees.openrepository.com/tees/bitstream/10149/560332/2/560332.pdf

  2. 3
    louis richard on October 10, 2016

    I was recently prescribed a TLSO race for Scoliosis. I am 81 years old and suffer from lower back pain. I had fusion of the L4 &L5 about 12 years ago, but I am told that is not the source of my pain. As I read more about the TLSO and scoliosis, I have doubts as to whether the TLSO is right for me. I t seems designed for young growing people. What do you think?

    1. 4
      Dr. Josh Woggon on October 10, 2016

      Hello,
      There are many different types of TLSO braces; some, like the Boston brace, are intended to be worn during periods when the spine is still growing. There have been a couple of case studies lately suggesting that some types of braces may be more effective for pain management in adults. You may want to consider the Gensingen brace (available from Dr. Marc Moramarco in Massachusettes, http://www.drmoramarco.com) or a LSO (a brace for just the low back, as described in the second study below). I have also heard presentations on the effectiveness of the SpineCor dynamic brace for helping adults with scoliosis alleviate their pain, so this may be another option.
      Of course, I wouldn’t be doing my job if I didn’t mention that many adults with scoliosis have found pain relief and improved quality of life by going through the CLEAR program, as well! If you are interested, I’d encourage you to find a CLEAR doctor near you (just click on Find a Doctor at the top-middle or bottom-left of the page) and schedule a consultation either over the phone or in person to explore whether CLEAR treatment might be able to help you with your pain.
      I hope this information has been helpful, and that you can find an option which will get you the results you’re looking for!

      Gensingen brace, Dr. Marc Moramarco: https://www.ncbi.nlm.nih.gov/pubmed/27630444
      Custom-made LSO’s (from Lyon, France I believe): https://www.ncbi.nlm.nih.gov/pubmed/27343345

  3. 5
    Phyllis A Jean on October 26, 2016

    I am 87 yrs. old and have been wearing a Case TLSO brace for 11 years due to
    osteoporosis, fracture T10 of my spine in 2002 and then T12 burst in 2006. I need it
    replaced. The place I purchased it has sort of changed. They no longer list their
    clinical people, so that you can compare them. I don’t feel comfortable going there.
    Any suggestions?

    1. 6
      Dr. Josh Woggon on October 26, 2016

      Hello,
      I’m afraid I’m not familiar with the Case brace, and I can’t find any information about it online. Did you mean the Copes brace perhaps, with the air bladders?
      You may want to look into the ScoliBrace (www.scolibrace.com), the Gensingen brace (www.drmoramarco.com), or the Rigo-Cheneau brace (www.rigo-cheneau.us). The SpineCor dynamic brace is sometimes also effective for pain relief in adults. If you’d like to consider a non-bracing approach, please contact us at care@clear-institute.org and we can help you find the CLEAR Certified Doctor nearest you!

  4. 7
    RAMAN BAJRAMI on March 14, 2017

    53 y old male. compressive fracture of L1. 6 weeks after injury should i were TLSO korset 24 h or can i take it off during night. p s no neurological defects

    1. 8
      Dr. Josh Woggon on March 14, 2017

      Wearing a hard, rigid brace for extended periods of time is not usually recommended, as it can lead to muscle atrophy and accelerate the process of spinal degeneration by restricting motion. The SpineCor brace has been shown to be effective in relieving pain in adults with scoliosis; have you considered switching to this type of soft, dynamic brace instead? In regards to night-time bracing, most scoliosis experts do not feel that wearing the brace at night has a substantial benefit even in adolescents, except perhaps for some types of thoracolumbar “C” curves. In adults, where the pain is usually due to overuse of the muscles and degeneration of the discs, wearing a brace at night would almost never be recommended in most cases.
      I’m afraid I can’t give any advice pertaining to the fracture; it would be necessary to review x-rays and imaging in order to evaluate the extent of the fracture and how well it’s healed over 6 weeks in order to make accurate recommendations.

  5. 9
    J Farnsworth on April 30, 2017

    I have an enlarged heart and when I slouch over and compress my guts then press on my heart and cause PVCs and VTs setting my ICD to defib me. In other words I need a product to wrap around the top of my hips and not my stomach and then keep me sitting up straight with shoulder back. Does anyone know where I can get a product like that? I am having difficulty finding anything like that.

    1. 10
      Patient on May 24, 2017

      Consult your family doctor. He/she may refer you to a specialist. You may need to get a brace prescribed by your doctor and a custom made LSO or TLSO from a certified orthotist.

  6. 11
    Virginia Taylor on August 10, 2017

    My daughter is 15 and has scoliosis. She has severe adolescent idiopathic scoliosis of the dorsolumbar spine with left ward convexity consistent with levoscoliodis and have a very high risk of continuing to worsen. I was told to get a tlso brace. I had a second person telling me that she needs a scoliosis brace. What is the right brace for her. She is an athlete running from she was five years old.

    1. 12
      Dr. Josh Woggon on August 10, 2017

      TLSO stands for Thoraco-Lumbar Sacral Orthosis. A scoliosis brace could mean anything; every type of brace for scoliosis is considered a scoliosis brace. The most common TLSO brace in the US is the Boston Brace. However, this is also one of the least effective braces in my opinion. I’ve been very impressed with Dr. Jeb McAviney’s ScoliBrace (www.ScoliBrace.com). The ideal brace should show at least a 50% reduction in the Cobb angle on an in-brace x-ray. There should also be a reduction in the AVR (apical vertebral rotation), and it should be worn for a minimum of 14-16 hours daily. If getting your daughter to wear the brace for this long is problematic, or if the brace doesn’t show evidence of effectiveness, you may want to consider trying the CLEAR method instead!

  7. 13
    Ryan on January 14, 2018

    In reading some of the replies and doing some of my own research, is the scolibrace complimentary to the CLEAR method (intensive) or can you complete the intensive CLEAR treatment without having to get the brace?

    Do you need the scolibrace if you do the do CLEAR method (intensive)?

    Thanks

    1. 14
      Dr. Josh Woggon on January 14, 2018

      CLEAR’s mission was to provide an alternative to people with scoliosis who, for whatever reason, didn’t get the results they wanted from bracing or surgery. We weren’t anti-bracing, per se, but we deliberately chose not to include bracing as part of our protocol.

      That said, Dr. Jeb McAviney (the founder of ScoliBrace) is a good friend of mine. He’s an amazing and intelligent individual whom I have nothing but the highest respect for. We are currently exploring whether or not his brace might enhance the effect of CLEAR treatment. You don’t need to wear a brace to complete CLEAR treatment, and the ScoliBrace isn’t a part of the CLEAR protocols. But with Dr. Jeb’s support, we are continuing our research in this area, and we look forward to sharing our findings with you and the rest of the scoliosis community!

  8. 15
    MIRIAM CASS on July 19, 2018

    WHAT IS THE BEST BRACE FOR SEVEN YEAR OLD GIRL? sHE IS VERY SENSITIVE SO WE ARE TRYING TO FIND A BRACE THAT SHE CAN STAND AND WILL IMPROVE HER SCOLIOSIS

    1. 16
      Dr. Josh Woggon on July 23, 2018

      There are many factors which go into determining the ideal brace for a specific individual. Smaller, mild cases of scoliosis might want to consider a dynamic brace such as the Gensingen or SpineCor. If the Cobb angle is over 20 degrees, a rigid brace is usually more appropriate; these include variants such as the Boston brace, the Cheneau, the SPoRT, and ScoliBrace. Ultimately, your best course of action is to consult with as many scoliosis specialists as possible (consider using our List of Questions to Ask Your Doctor as a helpful resource). Take detailed notes of their recommendations and suggested treatment strategies. Once you have reviewed this information, you will be better prepared to make effective & informed decisions. If there is anything we can do to help, please feel free to reach out to us at (866) 663-7030 or care@clear-institute.org.

  9. 17
    Damien Smyth on August 27, 2018

    I have a query on behalf of my Dad. He is 80 years old and was only recently diagnosed with scoliosis. He showed no signs of back/spinal problems until his mid 70’s and was quite fit and healthy his whole life. Over the past 5 years a severe curvature in his spine has become very visible and he has experienced a lot of pain on one side which travels right down his left leg into his foot. He has been using 20mg morphine patches for the past year but the effectiveness of the pain relief is becoming less and less. As we are in Ireland alternative treatments appear to be few. I found the various articles regarding the use of braces and other therapies on this page very interesting. Do you think a brace could benefit my Dad in terms of controlling the pain or could you recommend anywhere in the UK that could help? I fear that his mobility will become so limited that he will soon be unable to walk at all. Kind regards, Damien Smyth.

    1. 18
      CLEAR on August 27, 2018

      Thank you for reaching out, Damien. I’m sorry to hear of the troubles your father is having. That is difficult for a child to watch. Typical CLEAR Scoliosis Treatment does not involve bracing, so it would be difficult for us to determine if he would benefit from a brace. We currently do not have a location in Ireland. If you would like, you can find the closest CLEAR doctor to you on our website. If you are considering bracing, the most effective corrective brace is the ScoliBrace offered by a company called ScoliCare. Please let us know if we can be of further assistance. Best of luck.

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