Wherever possible, a combination of individual Orthoses should be used where possible to treat each individual fracture level as this is the most comfortable option for the patient.

ONLY where restriction of motion is needed around the upper thoracic spine from T3-T8 a combined CTLSO is required to ensure motion is restricted and these levels and so the spine does not move between a CTO and TLSO combination.

However, this should be avoided unless deemed absolutely essential as a CTLSO is very difficult for patients to tolerate and should only be used in cases where the spine is unstable and there is high risk of neurological deficit if the motion in this area is not restricted as fully as possible.

If a CTLSO is deemed clinically necessary by the Orthotist, always contact the referrer first to explain how invasive the treatment is and the difficulties the patient will face in tolerating this treatment to see if any other treatment options can be explored before agreeing to a CTLSO.

It is also important to explain the treatment to the patient and involve them in the decision making process wherever possible and appropriate.

In fitting a CTLSO it is very important to weigh up the risks of not providing treatment with the impact on the patient's quality of life.