Scoliosis is a three dimensional sideways (lateral) and rotatory curve of the spine. The most common form is Adolescent Idiopathic Scoliosis (AIS) and comprises about 80% of all cases. Idiopathic means that the cause of the curve is unknown. Yet current research has discovered gene markers that will provide a better understanding of how scoliosis happens in the future. Curves under 30 degrees are usually followed by the Orthopedic Surgeon on a regular basis to document progression. If progression is seen then a Scoliosis TLSO (Thoraco Lumbar Sacral Orthosis) may be ordered. A TLSO is a custom measured device that moves the spine in an opposite direction to the curve and holds the curve from progression.

At Lerman and Son, we use a digital laser scanner to measure the TLSO that corrects the spine at the time of measurement. The digital “model” is then carved out of a block of foam and the TLSO is custom molded. The TLSO is fit and trimmed to the patient before being finished and taken home. Typically the TLSO is worn 18-20 hours per day based on outcome studies of patients who have successfully avoided surgery. It is not worn during physical activity such as sports and is not worn while bathing. Core muscles are not active when the TLSO is on so any activity that exercises core muscles is beneficial. Also, any activity that maintains spinal flexibility may also be helpful in helping the ability of the TLSO to move the spine.

Between the TLSO and the body a tight fitting shirt needs to be worn. On warm days if the shirt becomes wet due to perspiration the shirt must be changed to a dry one. A wet shirt between the TLSO and body with heat can cause a skin rash. Avoid the use of lotions on the skin under the brace. Lotions tend to close skin pores increasing the possibility of sweating. The use of corn starch or baby powder on the skin may be helpful. The liner of the TLSO is perforated to help dissipate heat. It is important to clean the inside of the liner between the brace and the body to avoid any buildup of bacteria. We recommend the use of rubbing alcohol on a towel and clean the inside liner minimally 4 times per week.

At the time that the TLSO is taken home a mark is placed on the strap showing how tight the TLSO must be worn. The spine responds to the push of the brace in a similar way that teeth move when orthodontic braces are tightened. Unlike the orthodontist who leaves the patient in an uncomfortable position after until the teeth adjust, we loosen the TLSO strap about 2 inches and have it tightened slowly over the first 10 days of wear. This allows the spine to adjust to the TLSO is a way that is non-confrontational to the patient. After taking home the TLSO, an appointment should be made with the Orthopedic Surgeon for an xray in the TLSO 2-3 weeks after wearing it. It is important the strap on the TLSO be tightened to the mark at the time of xray so the doctor can see how the TLSO is working. Based on the xray, sometimes minor adjustments may be needed.

We are available to make any necessary adjustments to the TLSO over time and we do not charge a fee for follow-up visits. Sometimes it is helpful to apply rubbing alcohol to the skin 3 times a day wear the TLSO pads are moving the spine in order to thicken the skin and allow greater comfort. It is important to realize that we do not know when the actual biochemistry of growth occurs. Keep a regular chart of growth at home by marking a line on a wall and dating it. If 2-3” of growth occurs, the TLSO should be checked for fit and contact your Orthopedic Surgeon to see if a new one is needed.