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Fracture Bracing
LSO
An in-depth, evidence-based explanation of the lumbosacral orthosis (LSO) — a supportive brace for the lower spine used for certain fractures and lower back conditions.
A lumbosacral orthosis, or LSO, is a brace that supports the lower part of the spine — the lumbar region and the sacrum. Shorter than a full thoracolumbosacral brace, it is designed to support the lower back specifically. An LSO can be used to help manage certain lower lumbar fractures, and is also sometimes used to support the lower back in other painful conditions. It works by limiting movement, off-loading the lower spine, and providing a sense of support and comfort. This page explains what an LSO is, when it can be used, and what the evidence shows about its benefits and limits.
For information only — not medical advice. The content on this page is patient education to help you understand a condition or treatment. It is not a substitute for personalised assessment by a qualified clinician. Always consult your doctor or specialist about your own symptoms, diagnosis, and treatment decisions.
What an LSO is
An LSO encloses the lower trunk, from around the lower ribs to the pelvis, providing support to the lumbar and sacral spine. Braces range from rigid moulded shells to semi-rigid and elastic (soft) supports. A rigid LSO limits bending and twisting of the lower back, while softer supports provide compression, warmth and a reminder to move carefully rather than firm immobilisation. The type chosen depends on the purpose — firm immobilisation of a fracture calls for a rigid brace, whereas support for lower back pain may use a lighter one. Fitting is usually done with an orthotist.
When it can be used
In the fracture setting, an LSO may be used for certain stable fractures of the lower lumbar spine, where the aim is to support the segment and control pain during healing. More broadly, lumbosacral supports are sometimes used for episodes of lower back pain, both to ease symptoms and, in some occupational settings, as a support during recovery. As with all bracing, the decision depends on the specific problem, the stability of the spine, and the individual. Unstable fractures or those with neurological involvement require different management.
What the evidence shows
The evidence for lumbar supports is mixed and should be presented honestly. Systematic reviews, including Cochrane work, have found limited and inconsistent evidence that lumbar supports prevent low back pain or that they are clearly better than other treatments, though some trials suggest modest symptomatic benefit for certain people. For stable lower lumbar fractures, bracing is used pragmatically to support healing and comfort. The overall message is that an LSO can be a helpful support in the right situation, but it is not a cure and works best as part of a wider plan that includes activity and rehabilitation rather than prolonged reliance on the brace alone.
What to expect
Where an LSO is used for a fracture, it is generally worn when upright for a defined period, with review and imaging to confirm the fracture is stable and healing. Where used for back pain, it is usually worn for symptom relief during flare-ups rather than continuously, alongside staying active and building strength. Skin care and comfort under the brace matter, and prolonged unnecessary use is avoided so the trunk muscles stay active. The right approach depends on the individual and is decided with the treating team.
Disclaimer. The information provided on this page is intended for educational purposes only and should not be considered personalised medical advice. Every patient is different, and treatment options, risks, expected recovery and outcomes depend upon an individual's diagnosis, injury pattern, bone health, general health and personal circumstances. Decisions regarding treatment should always be made following consultation with your treating spinal surgeon or healthcare professional.
Evidence & further reading
- —van Duijvenbode IC, et al. Lumbar supports for prevention and treatment of low back pain. Cochrane Database Syst Rev 2008. (PMID 18425875)
- —Jellema P, et al. Lumbar supports for prevention and treatment of low back pain: a systematic review. Spine 2001. (PMID 11224885)
- —Gignoux P, et al. Non-rigid lumbar supports for non-specific low back pain: a review and meta-analysis. Ann Phys Rehabil Med 2022. (PMID 32561503)
- —Annaswamy TM, et al. Lumbar bracing for chronic low back pain: a randomised controlled trial. Am J Phys Med Rehabil 2021. (PMID 33789322)
- —Samani M, et al. Long-term use of soft lumbosacral orthoses in chronic non-specific low back pain: an RCT. Clin Biomech 2019. (PMID 31302494)
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