Five year's experience with the thoracic suspension orthosis at Newington Children's Hospital has shown it to be an effective and very useful adjunct in the management of neuromuscular spinal deformity. The orthosis converts the thorax into a weight-bearing structure, thereby reducing the vertical load on the spine and allowing the abdomen and pelvis to act as a corrective distraction force. Fifty-nine of the 64 patients reported here have successfully used the orthosis to control spinal deformity and improve their functional status. Analysis of these 59 patients and the 5 treatment failures has resulted in identification of the specific indications, prerequisites, techniques, precautions, and contraindications necessary for the achievement of stated treatment objectives, often with dramatic success.