Introducing the Thoracic Lumbar Sacral Orthosis (TLSO)

In scoliosis, the bones of the spine shift and rotate from where the middle of the spine should be, causing it to curve. Although it can affect anyone at any age, scoliosis is most commonly diagnosed between the ages of 9 and 16 and is known as adolescent idiopathic scoliosis.

When the curve is between 25-50 degrees on an X-ray and your child still has predicted growth remaining, the spine doctor may prescribe a scoliosis brace, also known as a Thoracic Lumbar Sacral Orthosis (TLSO).

The TLSO works by applying pressure over the back in specific areas to straighten the spine while your child is wearing the brace. Usually, the curvature of the spine will be reduced inside of the brace, but stay at the same degree of curve when the brace is removed.

Types of Bracing

There are many different types and manufacturers of scoliosis braces available. The type of brace will be determined by the spine doctor and your child’s orthotist (the clinician who fits the brace).

Typically, the braces are plastic on the outside, and the majority are lined on the inside with foam (although the foam lining is optional to allow for a thinner aesthetic). Different color patterns are available for children who want to personalize their brace.

Treatment Timeline

Typical treatment timelines range from 1-3 years, with the most common timeframe being about 2 years. Since the timeline is usually quite long, brace compliance is key.

In this case, compliance means wearing the brace for the number of hours indicated by your spine doctor and orthotist. The orthotist will work with your family to determine what is realistic in terms of wear time (taking into account sports, dance, activities, after-school commitments, etc.), so they can build a plan accordingly.

Full-time vs. Nighttime Bracing

The referring physician will make the decision as to whether your child needs to be in a full-time brace or a nighttime brace based on several different factors (bone age, chronological age, onset of menstrual cycle [in females], and curve magnitude).

The recommendation for full-time bracing is to wear the brace 16-20 hours a day, and the recommendation for nighttime bracing is to wear the brace 8-10 hours every night.

Studies show that full-time bracing worn for greater than 17 hours had a much higher success rate of preventing the progression of the curve than in patients who wore their braces for less than 17 hours. This reinforces the importance of brace compliance and ensuring the brace is being worn as prescribed.1

It is also important to note that the nighttime brace will maximize the in-brace correction for fewer hours each day. The decision between full-time bracing and nighttime bracing is often discussed with the spine doctor, orthotist, patient, and family.

Depending on the child’s growth, full-time braces last about 12 months and nighttime braces last anywhere from 18-20 months. Some children may require more than one brace over the course of treatment.

The Hanger Clinic Difference

Our team of expert clinicians established Clinical Practice Guidelines for treating adolescent idiopathic scoliosis based upon 2016 SOSORT International Society on Scoliosis Orthopedic and Rehab Treatment consensus findings.

These guidelines serve as the standard of care at Hanger Clinic and include five different areas that help ensure Hanger Clinic clinicians treating scoliosis patients have the necessary experience and education to provide the best possible care and outcomes.

The Clinical Practice Guidelines include seven different biomechanical design considerations to ensure all braces provided through Hanger Clinic are fabricated to a specific, high-quality standard.