Thoracic-Lumbo-Sacral-Orthosis (TLSO)

Your child is healing from back surgery or a back injury. The Thoracic-Lumbo-Sacral-Orthosis (TLSO) is used to stabilize or hold the spine to prevent progressive scoliosis and protect him/her following surgery from local trauma as healing takes place. For this to be successful, the brace must be properly worn and cared for. The brace was especially made to fit your child.

Wearing Time

After spinal surgery, the TLSO may be fastened so that it cannot be removed. This means that the brace is worn instead of a cast. Your doctor will decide when the brace will be removed.

Skin Care

Daily skin care is very important. The skin should be kept clean by washing with soap and water. Dry it well. Rub the skin around the edges of the brace with rubbing alcohol. This will toughen it. Do not use oily or greasy ointments where the brace touches it. These soften the skin and may cause it to break down. If it becomes red or irritated, stop using the rubbing alcohol. After the skin is no longer red, or irritated you may begin to use the rubbing alcohol again. For any special questions regarding skin care, please contact the orthopaedic nurse.

Brace Care

The hard plastic outer shell should be cleansed every time your child takes a sponge bath. A cloth with soap and water can be used to clean it, followed by a damp rinsing cloth. A terry towel or hair dryer (on a cool setting) can help dry the plastic cover. If the brace is removable, the inner foam plastic liner can be cleansed in the same way. The Velcro strap should last about six months. If the Velcro is not keeping the straps closed, they can be replaced in the brace shop.

Exercise and Activities

Follow the doctor's instructions for the amount of activity your child does. He/she may get up and about as tolerated. He/she should not resume other activities until the doctor says so.

Clothing

It is usually necessary to wear clothing over the brace that is larger than your child has been wearing. As a rule, loose fitting clothes will not reveal the outline of the brace. Pants with elastic waistbands may fit more easily. Your child must wear a t-shirt under the brace. We recommend a plain, 100% cotton t-shirt, which allows free circulation of air better than a polyester blend. We suggest that you prepare the cotton t-shirt before your child's surgery or brace fitting and have one ready for the day the brace is put on. The t-shirt needs to be changed each day and more often as needed, if it becomes dirty or wet.
Figure A: Tie shoestrings to the bottom of t-shirt as shown
Change of T-shirt under a Fastened Brace (TLSO)

Equipment/supplies

1. At least 2 clean, form fitting, cotton t-shirts. Sew 6 button holes or 6 loop tabs at the hem. Two each on the front, sides and back.

2. Three pair of long (45 inches or 54 inches) shoestrings with the plastic tips cut off.

A clean t-shirt is put on your child. This t-shirt should have the 6 button holes or 6 loop tabs at the hem. (Figure A)
The brace is then put on your child.
Figure B
To change the T-shirt:

1. First, tie the shoestrings to the bottom of the dirty t-shirt. The child should lie down and roll on his/her side to make it easier to pull the t-shirt out from under the brace. (Figure B)

2. Release the Velcro straps at the child's shoulders.

3. While lying on the bed and rolling front to side to back, pull the t-shirt up at the neck and shoulders. Make sure that the strings hang out under the lower edge of the brace. (Figure B)
Figure C: Demonstrates how to remove dirty t-shirt

4. After the t-shirt is out from under the brace, untie the strings from the bottom of the dirty t-shirt.

5. Remove the dirty t-shirt. Leave the strings in place
under the brace. (Figure C)


6. Place the clean t-shirt over the child's head and insert arms in the sleeves.

7. Tie the strings to the clean t-shirt (Figure D) and while your child is lying down and rolled from side to back to side, gently pull the shoestrings downward, under the brace.
Figure D: Demonstrates how to put on clean t-shirt


8. After the t-shirt is in place under the brace, take off the strings and fasten the Velcro shoulder straps.

Emotional

Your child may be afraid at first. Go slowly and give them support during the t-shirt change. Let him/her know that you will try to be gentle and take special care to make it as easy as possible for him/her.


Please call the Orthopaedic Clinic nurses with any questions or problems with your child's care. Call for any redness, painful rubbing of the brace or drainage on the dirty t-shirt.