What Is a Thoracic Lumbar Sacral Orthosis?

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If you have back pain, your physician or physical therapist may prescribe a brace to help control motion of your spine. A special back brace called a thoracic lumbar sacral orthosis (TLSO) may be prescribed for this.

A TLSO is a brace that limits movement in your spine from the thoracic area (mid back) to your sacrum (low back). It does allow your neck to move freely.

If you have a problem with your back that requires it to be kept in a neutral position while limiting excessive spinal motion, then a TLSO may be an option for you. Knowing what it is and how it is used can help you make an informed decision about using a TLSO.

Ultimately, you should work closely with your physician when deciding to use a TSLO or any other spinal bracing for your specific condition.

Picture of a man in a back brace.

Aleksandr Zhurilo / Getty Images

Conditions Treated

There are several different conditions where a thoracic lumbar sacral orthosis may be used. These may include, but are not limited to:

Any condition or injury that may cause an injury to your spine may require the use of bracing to correct the problem. The goal of the TLSO is to hold your spine in appropriate alignment as you heal from injury.


Scoliosis is a lateral (sideways) curvature of the spine. It often is diagnosed in childhood or the teen years. Scoliosis may cause pain and difficulty with movement.

The treatment for scoliosis involves maintaining spinal alignment to prevent worsening of the lateral curvature. Often, a TLSO will be prescribed to maintain spinal alignment as the child is growing into full adulthood.

Herniated Disc

A herniated disc in your low back may cause pain in your back or down one leg. It occurs when the soft material in the center of a spinal disc leaks out and puts pressure on a spinal nerve root.

Your physician may prescribe a thoracic lumbar sacral orthosis to wear while your herniated disc is healing. The orthosis can help limit spinal motion and may keep the disc from compressing nerves from your back.

Compression Fracture

If you have a spinal compression fracture, either due to trauma or osteoporosis, your physician may have you wear a TLSO to minimize spinal motion while your fracture is healing. After a few weeks of healing, your doctor may have you slowly wean out of wearing the TLSO to gradually restore normal movement.


If you have significant trauma like a fall or automobile accident, your physician may have you wear a TLSO to keep your back in good alignment while you are healing. Gradually you can use the TLSO less and less as things heal.


If you have had lumbar surgery, like a discectomy or spinal fusion, your doctor may have you wear a thoracic lumbar sacral orthosis in the immediate post-operative period. This is done to maintain spinal alignment and allow your tissues to heal after surgery.

After a few weeks, the TLSO may be worn less and less, and you can gradually regain normal mobility.

Seating Position in Children

A thoracic lumbar sacral orthosis may be used to help children maintain appropriate sitting positions. Some children with cerebral palsy experience sitting problems due to muscle spasm or trunk weakness. A TSLO can be used to keep the child’s trunk in an upright position while sitting.

Components of the Thoracic Lumbar Sacral Orthosis

Several different components make up a TLSO. Typically, two plastic braces are used, one in the front and one in the back. These hard plastic chest and back pieces are covered in a soft and padded material for comfort.

The front and back hard plastic braces are held together with straps on one or both sides. The straps are adjustable with hook-and-loop fasteners. Some TLSO braces have soft fabric on one side, offering comfort between your body and the straps that hold the brace in place.

Some thoracic lumbar sacral orthoses are adjustable once the brace is worn. Two elastic cords or straps, one on each side, may wrap around the two hard plastic pieces of the brace. When these are pulled together, the brace becomes more snug, fitting a bit tighter.

Donning the Thoracic Lumbar Sacral Orthosis

Your physician or physical therapist should give you specific instructions for how to put on your thoracic lumbar sacral orthosis. In general, to put the device on, simply place the back pad on your back, ensuring it extends from your mid back to just above your buttocks where your sacrum is located.

Then, bring the front pad around to your chest, and lightly fasten the straps with the hook-and-loop fasteners. Stand upright, and tighten each strap so the TLSO fits snugly but comfortably. You should be able to breathe while wearing your TLSO.

A good rule of thumb to follow: When wearing your TLSO brace, you should be able to slide two fingers beneath the plastic chest and back piece, and beneath the straps. If you cannot fit two fingers beneath your brace, it is too tight.

How Long to Use the TLSO?

The length of time you wear your thoracic lumbar sacral orthosis depends on your condition and your physician’s instructions. The device may be worn for several hours a day for two to three years to maintain spinal alignment in a developing teenager with idiopathic scoliosis.

After surgery, the TLSO may be prescribed in the initial healing period, usually lasting for four to eight weeks. You may also wear a TLSO for four to eight weeks if you are healing from a fracture from trauma or a compression fracture of the spine.

Caution should be used to wear the TLSO only as prescribed. Long-term use of a spinal brace may have adverse effects. First, wearing a brace may make your core muscles weak and tight, leading to difficulty with movement.

A thoracic lumbar sacral orthosis may also limit diaphragmatic function, which is essential for normal breathing. If the TLSO is too tight, you may find that lung function is impaired; wearing your brace properly and as prescribed is important.


If you have back pain or an injury to your back that requires you to keep your spine in a neutral position while it heals, then you may benefit from a thoracic lumbar sacral orthosis. A TLSO can provide support as your body heals, and it may prevent worsening of scoliosis in your spine.

A Word From Verywell

Understanding the uses and limitations of a thoracic lumbar sacral orthosis can help you and your physician decide if it is the right brace for you. Wearing it correctly is important in getting the most benefit from it.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Corradin M, Canavese F, Dimeglio A, Dubousset J. Cervical sagittal alignment variations in adolescent idiopathic scoliosis patients treated with thoraco-lumbo-sacral orthosisEur Spine J. 2017;26(4):1217-1224. doi:10.1007/s00586-016-4884-7

  2. Goto T, Sakai T, Sugiura K, et al. A semi-rigid thoracolumbar orthosis fitted immediately after spinal surgery : stabilizing effects and patient satisfactionJ Med Invest. 2019;66(3.4):275-279. doi:10.2152/jmi.66.275

  3. Karimian M-R, Yeowell G, Saberi S, Sadeghi-Demneh E. A comparison of the effectiveness of three types of trunk orthoses on the balance performance of older people with osteoporotic hyperkyphosis: a cross-over study. Musculoskelet Sci Pract. 2021;55:102430. doi:10.1016/j.msksp.2021.102430

By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.