Wearing your CTLSO
What is a CTLSO?
A CTLSO (Cervical-Thoraco-Lumbo-Sacral 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 activities 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 TLSO being pushed upward by seat cushions. Bend at your hip and knees, but not your back when getting into and out of a vehicle, 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 CTLSO is off.
Putting on your CTLSO
You have been given 3 T-shirts to wear under the CTLSO. Wash and reuse the T-shirts. They can be hand-washed and dried on a towel or drying rack, or see the instructions in the package. Put on your CTLSO while still lying down. IMPORTANT: 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 CTLSO should be fastened. If you can tighten the straps past the marked lines, do so. If the CTLSO is “riding up” on you it is too loose. Lie down, move the CTLSO to the correct place and tighten the straps again. Your doctor will tell you when to wear your brace during the day and for how long to wear it. Always wear a T-shirt under the brace to provide a barrier between your skin and the plastic and to absorb perspiration.
Steps:
1. 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.
2. Roll to the opposite 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.
3. The caregiver should position the back half of the brace. Making sure the waist indentations on the inside of the brace are just above the hip bones and below the ribs.
4. Hold the brace in place and log roll onto your back.
5. Position the front half of the brace
-Fully tighten both straps at bottom of brace on both sides.
-Fully tighten the straps at the top of the brace on both sides.
-Check to see that the brace is aligned before getting up and adjust if necessary.
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 while the CTLSO is off.
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.
Showering/bathing
If your doctor has told you to wear your CTLSO 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 CTLSO. In both cases, clean the inside of the CTLSO 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 CTLSO is off. After your skin and the inside of the CTLSO are both dry, put the CTLSO on again before sitting or standing. You can wear the CTLSO with wet straps or dry them with a hair dryer set on low.
If your doctor allows you to shower without the CTLSO, remove it just before starting the water and put it on again as soon as you dry off. Be careful not to twist or bend your back while the CTLSO is off.
Sleeping in the CTLSO
Your doctor will tell you if you should wear your CTLSO while sleeping or lying down. Your doctor may change these instructions during your course of treatment based on changes in your condition. If you are allowed to remove the CTLSO 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 CTLSO
Wipe off the outside with a damp or soapy cloth, and then dry. The straps may be scrubbed with a brush on the smooth Dacron side. They can air dry while the CTLSO is being worn. The hook fastener area will hold best if all the lint is removed.
Cleaning the inside of the CTLSO
The CTLSO is lined with waterproof closed cell foam. When you take your CTLSO 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 CTLSO and dry the inside with a towel or a hair dryer set on “low” or “cool” before you put it on again. Once a week, wipe out the inside of the CTLSO with rubbing alcohol. While the CTLSO is off, change your T-shirt and dry any sweat from your skin so all places under the CTLSO are dry. Do not use cornstarch on your skin. You may use medicated talcum powder if you like.
Daily Activities
Your CTLSO 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 CTLSO. 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 CTLSO. You must be sure to 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 Remember
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 should I do if my neurological symptoms get worse?
If you have more numbness, tingling, pain or are less able to move or do daily activities, call:
Patients of the Neurosurgery Clinic: (608) 263-1410
Patients of the Orthopedic Rehabilitation 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.
If you live out of the area, please call 1-800-323-8942 and ask for your clinic.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 09/19/2012
Copyright © 08/31/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7404
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