A Cervical Thoracic Lumbar Sacral Orthosis (CTLSO) can be 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 patients quality of life.