thoracolumbosacral orthosis (TLSO)
/ TLSO = T-L-S-O /
When a spinal fracture or major spine surgery means the back must be kept from bending and twisting while bone heals, a small belt is not enough. A thoracolumbosacral orthosis, or TLSO, is a trunk brace that encloses the body from the upper chest down to the pelvis, controlling the thoracic (chest), lumbar (lower back), and sacral regions of the spine together.
Most rigid TLSOs are essentially a custom-moulded plastic shell that fits the trunk like armour — often a two-piece front-and-back design closed with straps, which is why it is nicknamed a clamshell or body jacket. By gripping the rib cage above and the pelvis below and pressing on the abdomen, it sharply limits how far the spine can bend forward, lean sideways, or rotate, holding the healing or unstable segment quiet. Softer fabric versions with metal stays restrict far less and are used more for support and pain in less serious problems.
TLSOs are common after spinal fractures, after fusion surgery, and in some progressive spinal deformities. The same caveats as all rigid trunk bracing apply, only more so: weeks in a TLSO weaken the trunk and deep core muscles and stiffen the spine, the enclosed skin can break down (especially over the bony spine, hips, and groin), and the brace is hot and confining. So it is fitted for the specific healing period and weaned as the bone or fusion becomes solid, with rehabilitation afterward to rebuild the muscles the brace replaced.
After a stable fracture of a lower thoracic vertebra, a woman is fitted with a custom clamshell TLSO that she wears whenever she is upright. It holds her spine from bending while the bone knits; three months later, with healing confirmed, she weans out of it and works on rebuilding her trunk strength.
A trunk shell from chest to pelvis that limits spinal bending and twisting while bone or a fusion heals.
Weeks in a rigid TLSO weaken the core and stiffen the spine, and the enclosed skin can break down — so it is fitted for a defined healing window and weaned, with rehab to rebuild the muscles afterward.