TLSO Brace Candidacy for Thoracolumbar Spine Injuries
Primary Indications
- Neurologically intact patients with AO Type A3 burst fractures between T11-L3 are the classic candidates for TLSO consideration 1, 2
Key Clinical Decision Point
- The American Association of Neurological Surgeons provides a Grade B recommendation that management with or without external bracing produces equivalent outcomes—the decision is at the treating physician's discretion 1
Evidence Against Routine Bracing
- Level I randomized controlled trial evidence shows no difference in pain, disability, or radiographic outcomes between braced and non-braced patients at 6 months 1
Absolute Contraindications to Conservative Management
- Significant vertebral collapse, angulation, or canal compromise 1
- Any neurological deficit present 1
- Fractures with TLICS score >4 suggesting instability 3
- Evidence of shear, rotation, or translational injury components 1
Common Pitfalls to Avoid
- Do not assume bracing is mandatory—high-quality evidence supports early mobilization without orthosis as equally effective 1
- Do not order TLSO for patients with neurological deficits—these require surgical evaluation 1
Spinal Support with TLSO and LSO Braces
Clinical Applications and Effectiveness
- For thoracolumbar burst fractures in neurologically intact patients, high-quality evidence shows that both external bracing (TLSO) and no bracing provide equivalent clinical outcomes, with a grade B recommendation that management either with or without an external brace is acceptable 4, 5, 6
- The American Association of Neurological Surgeons recommends that the decision to use an external brace for thoracolumbar burst fractures should be at the treating physician's discretion, as bracing is not associated with increased adverse events compared to no brace 4, 5