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What is a CTLSO?
A CTLSO (cervical-thoracolumbosacral orthosis) is a two-piece plastic brace with a metal cervical attachment. It works like a body cast that can be removed.
Your CTLSO must be worn tightly. It should reduce or prevent harmful motion in your back and neck. It should be uncomfortable when you begin moving into positions you should avoid. You should be able to do many normal tasks by yourself or with a little help from caregivers or an assistive device. Ask your doctor for detailed guidelines and restrictions.
Planning for Your Trip Home
Arrange for someone to drive you home. Firm seats will prevent the back-bottom edge of your brace being pushed upward by seat cushions. Bend at your hip and knees, but not your back when getting into and out of a car, sitting or standing. A car with seats that recline is the best choice.
Taking off Your CTLSO
You must wear your CTLSO as ordered by your doctor. You are going to need help getting in and out of it. To remove it, lie down, open the straps, and remove the front shell. Someone must log roll you onto your side or stomach, then remove the back shell. Be careful not to twist or bend your back or neck while the brace is off.
Putting on Your CTLSO
You have been given three shirts to wear under your brace. Wash and reuse the shirts. They can be hand-washed and dried on a towel or drying rack. See the instructions in the package.
You will need someone to help you put on the brace and you must do it lying down. The CTLSO waist groove must be placed low on your waist (the soft space on your side between your hipbone and your ribs). Close the straps evenly and snugly (you may need help). The marks on the straps are a guideline as to how tightly the brace should be fastened. If you can tighten the straps past the marked lines, do so.
If the brace is “riding up” on you it is too loose. Lie down, move the brace to the correct place and tighten the straps again. Your doctor will tell you when you need to wear your brace during the day and how long you’ll need to wear it. Always wear a shirt under the brace to protect your skin and to absorb sweat.
Move to one side of the bed by using your arms and legs to move your hips over or having a caregiver pull the sheet under you over to one side.
Roll to the other side of the bed almost onto your stomach. Bend both legs by sliding your heels toward your buttocks. Lower your knees and turn your hips and shoulders. Do not twist! Roll like a log.
The caregiver should put the back half of the brace in place. Make sure the waist indentations on the inside of the brace are just above the hip bones and below the ribs. The bottom of the brace should be at your coccyx (tailbone).
With the caregiver holding the brace in place, log roll onto your back.
Put the front half of the brace in place. First, tighten the middle straps on both sides of the brace, then fully tighten both straps at bottom of brace on both sides. Fully tighten the straps at the top of the brace on both sides. Tighten the middle straps again as needed. Check to see that the brace lines up before getting up and adjust if needed.
Tighten straps from the back-head piece to chin piece so they are snug but not too tight. If the brace also has shoulder straps, tighten for a snug fit when standing. Both neck and shoulder straps will be loose when lying or sitting.
The chin piece will be much lower than the chin when lying flat on your back but will get closer to chin as you sit up. When sitting at 90 degrees or standing, the chin section should be up against the chin and the head section against back of head.
Getting out of Bed
Log roll onto your side. Drop your legs over the side of the bed and push yourself up to a sitting position.
Getting into Bed
Sit on the side of the bed and lean down on your elbow and forearm. Lift your legs up onto the bed, staying in the side lying position. Log roll from your side onto your back.
If your doctor has told you to wear your brace at all times when standing or sitting, you may have sponge baths with the brace off while lying in bed or take showers while wearing the brace. In both cases, clean the inside of the brace while you are lying on your bed. If you shower, you should lie on the bed when you are done and sponge bathe the area under the brace. Be careful not to twist or bend your back while the brace is off.
After your skin and the inside of the brace are both dry, put the brace on again before sitting or standing. You can wear the brace with wet straps or dry them with a hair dryer set on low.
Sleeping in Your Brace
Your doctor will tell you if you should wear your brace while sleeping or lying down. Your doctor may change these instructions during your course of treatment based on how you are healing. If you can remove the brace while sleeping, be sure to put it on before you get up. If you need to go to the bathroom during the night, it may be easier to keep the brace on.
Cleaning the Outside of the Brace
Wipe off the outside with a damp or soapy cloth, and then dry. You may scrub the straps with a brush on the smooth side. They can air dry while you wear the brace. The hook fastener area will hold best if all the lint is removed.
Cleaning the Inside of the Brace
The brace is lined with waterproof closed cell foam. When you take your brace off for your bath, wipe the inside with a damp cloth. If you prefer, you may also use a mild soap that you would use on your skin. Rinse the soap off the brace and dry the inside with a towel or a hair dryer set on “low” or “cool” before you put it on. Once a week, wipe out the inside of the brace with rubbing alcohol. While the brace is off, change your shirt and dry any sweat from your skin so all places under the brace are dry. Do not use cornstarch on your skin. You may use talcum powder if you like.
Your brace will make it hard to bend over and also make you more top-heavy than usual. Avoid bending over to reach your feet or the floor. Bend at the knees and hips, not the waist. You may need help or special tools to dress, pick things up from the floor, or wipe after going to the bathroom. An occupational therapist can provide tools and teach you new ways to do things while wearing your brace. Be careful on stairs and use handrails.
How long do I need to wear the CTLSO?
Your doctor will decide how long you need to wear your brace. Follow your doctor’s advice even if you feel better and would like to stop wearing it sooner. Your doctor will be checking your progress and will decide what is in your best long-term interest.
Things to Know
Do not expect to be able to move in all directions or sit in all types of chairs. The brace is designed to limit certain motions and positions.
If you have localized redness, call your orthotist so they can make changes to your brace. Redness over a large area of skin and pink in color is usually normal.
What do I do if CTLSO if not fitting right or causing pain?
Patients should call the Orthotics Clinic at (608) 263-0583 to schedule a visit to adjust the brace.
When to Call
Less able to move or do daily activities
Who to Call
Patients of the Neurosurgery Clinic: (608) 263-1410
Patients of the Orthopedic Spine Clinic: (608) 265-3207
After hours, nights, weekends, and holidays, this will give you the paging operator. Ask for the resident on call for your clinic. Leave your name and phone number with the area code. The doctor will call you back.