Bracing After Surgical Stabilization of Thoracolumbar Fractures

A Systematic Review of Evidence, Indications, and Practices

Jesse Skoch, Carmine Zoccali, Orel Zaninovich, Nikolay Martirosyan, Christina M. Walter, Philip Maykowski, Mhd-Ali - Baaj

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Background The role of spinal orthotic braces after surgical stabilization is not clearly defined. We systematically reviewed the published literature to determine patterns of practice, indications, and current evidence for the use of orthotic braces after surgical thoracolumbar fracture stabilization. Methods A search was performed for publications including descriptions of postoperative management and outcomes after surgical stabilization of thoracolumbar injuries. Differences between wearing versus not wearing a postoperative brace were examined with regard to loss of deformity correction, pain, return to previous work activity, functional improvement, instrumentation failure rate, pseudoarthrosis, and the percentage of reported complications. Results This search yielded 76 pertinent studies. Postoperative bracing (POB) was adopted in 62 studies for a median wear time of 13.3 weeks. No significant differences in terms of pain, return to work, Frankel score improvement, or instrumentation failure were found between the POB and non-POB groups. Loss of surgical kyphotic reduction was slightly greater in the POB group (4.79° vs. 3.77°; P < 0.001). The overall complication rate was also higher in the POB group (16.3% vs. 11.9%; P < 0.01). The pseudoarthrosis rate was lower in the braced group (2.4% vs. 6.0%; P < 0.001). Conclusions Most surgeons use braces for 3 months after surgical thoracolumbar fracture stabilization. Given the lack of clinical or biomechanical evidence for this, and the additional costs and potential discomfort to patients, further investigation is warranted to determine when and if POB for surgically stabilized thoracolumbar fractures is indicated. Controlled studies should include a careful analysis of pseudoarthrosis and complication rates.

Original languageEnglish (US)
Pages (from-to)221-228
Number of pages8
JournalWorld Neurosurgery
Volume93
DOIs
StatePublished - Sep 1 2016

Fingerprint

Braces
Pseudarthrosis
Return to Work
Pain
Publications
Costs and Cost Analysis
Wounds and Injuries

Keywords

  • Brace
  • Fracture
  • Orthosis
  • Orthotic
  • Spine
  • Trauma

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Bracing After Surgical Stabilization of Thoracolumbar Fractures : A Systematic Review of Evidence, Indications, and Practices. / Skoch, Jesse; Zoccali, Carmine; Zaninovich, Orel; Martirosyan, Nikolay; Walter, Christina M.; Maykowski, Philip; Baaj, Mhd-Ali -.

In: World Neurosurgery, Vol. 93, 01.09.2016, p. 221-228.

Research output: Contribution to journalArticle

Skoch, Jesse ; Zoccali, Carmine ; Zaninovich, Orel ; Martirosyan, Nikolay ; Walter, Christina M. ; Maykowski, Philip ; Baaj, Mhd-Ali -. / Bracing After Surgical Stabilization of Thoracolumbar Fractures : A Systematic Review of Evidence, Indications, and Practices. In: World Neurosurgery. 2016 ; Vol. 93. pp. 221-228.
@article{f1bc5a6b325041d386a237c038096e96,
title = "Bracing After Surgical Stabilization of Thoracolumbar Fractures: A Systematic Review of Evidence, Indications, and Practices",
abstract = "Background The role of spinal orthotic braces after surgical stabilization is not clearly defined. We systematically reviewed the published literature to determine patterns of practice, indications, and current evidence for the use of orthotic braces after surgical thoracolumbar fracture stabilization. Methods A search was performed for publications including descriptions of postoperative management and outcomes after surgical stabilization of thoracolumbar injuries. Differences between wearing versus not wearing a postoperative brace were examined with regard to loss of deformity correction, pain, return to previous work activity, functional improvement, instrumentation failure rate, pseudoarthrosis, and the percentage of reported complications. Results This search yielded 76 pertinent studies. Postoperative bracing (POB) was adopted in 62 studies for a median wear time of 13.3 weeks. No significant differences in terms of pain, return to work, Frankel score improvement, or instrumentation failure were found between the POB and non-POB groups. Loss of surgical kyphotic reduction was slightly greater in the POB group (4.79° vs. 3.77°; P < 0.001). The overall complication rate was also higher in the POB group (16.3{\%} vs. 11.9{\%}; P < 0.01). The pseudoarthrosis rate was lower in the braced group (2.4{\%} vs. 6.0{\%}; P < 0.001). Conclusions Most surgeons use braces for 3 months after surgical thoracolumbar fracture stabilization. Given the lack of clinical or biomechanical evidence for this, and the additional costs and potential discomfort to patients, further investigation is warranted to determine when and if POB for surgically stabilized thoracolumbar fractures is indicated. Controlled studies should include a careful analysis of pseudoarthrosis and complication rates.",
keywords = "Brace, Fracture, Orthosis, Orthotic, Spine, Trauma",
author = "Jesse Skoch and Carmine Zoccali and Orel Zaninovich and Nikolay Martirosyan and Walter, {Christina M.} and Philip Maykowski and Baaj, {Mhd-Ali -}",
year = "2016",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2016.05.067",
language = "English (US)",
volume = "93",
pages = "221--228",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Bracing After Surgical Stabilization of Thoracolumbar Fractures

T2 - A Systematic Review of Evidence, Indications, and Practices

AU - Skoch, Jesse

AU - Zoccali, Carmine

AU - Zaninovich, Orel

AU - Martirosyan, Nikolay

AU - Walter, Christina M.

AU - Maykowski, Philip

AU - Baaj, Mhd-Ali -

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background The role of spinal orthotic braces after surgical stabilization is not clearly defined. We systematically reviewed the published literature to determine patterns of practice, indications, and current evidence for the use of orthotic braces after surgical thoracolumbar fracture stabilization. Methods A search was performed for publications including descriptions of postoperative management and outcomes after surgical stabilization of thoracolumbar injuries. Differences between wearing versus not wearing a postoperative brace were examined with regard to loss of deformity correction, pain, return to previous work activity, functional improvement, instrumentation failure rate, pseudoarthrosis, and the percentage of reported complications. Results This search yielded 76 pertinent studies. Postoperative bracing (POB) was adopted in 62 studies for a median wear time of 13.3 weeks. No significant differences in terms of pain, return to work, Frankel score improvement, or instrumentation failure were found between the POB and non-POB groups. Loss of surgical kyphotic reduction was slightly greater in the POB group (4.79° vs. 3.77°; P < 0.001). The overall complication rate was also higher in the POB group (16.3% vs. 11.9%; P < 0.01). The pseudoarthrosis rate was lower in the braced group (2.4% vs. 6.0%; P < 0.001). Conclusions Most surgeons use braces for 3 months after surgical thoracolumbar fracture stabilization. Given the lack of clinical or biomechanical evidence for this, and the additional costs and potential discomfort to patients, further investigation is warranted to determine when and if POB for surgically stabilized thoracolumbar fractures is indicated. Controlled studies should include a careful analysis of pseudoarthrosis and complication rates.

AB - Background The role of spinal orthotic braces after surgical stabilization is not clearly defined. We systematically reviewed the published literature to determine patterns of practice, indications, and current evidence for the use of orthotic braces after surgical thoracolumbar fracture stabilization. Methods A search was performed for publications including descriptions of postoperative management and outcomes after surgical stabilization of thoracolumbar injuries. Differences between wearing versus not wearing a postoperative brace were examined with regard to loss of deformity correction, pain, return to previous work activity, functional improvement, instrumentation failure rate, pseudoarthrosis, and the percentage of reported complications. Results This search yielded 76 pertinent studies. Postoperative bracing (POB) was adopted in 62 studies for a median wear time of 13.3 weeks. No significant differences in terms of pain, return to work, Frankel score improvement, or instrumentation failure were found between the POB and non-POB groups. Loss of surgical kyphotic reduction was slightly greater in the POB group (4.79° vs. 3.77°; P < 0.001). The overall complication rate was also higher in the POB group (16.3% vs. 11.9%; P < 0.01). The pseudoarthrosis rate was lower in the braced group (2.4% vs. 6.0%; P < 0.001). Conclusions Most surgeons use braces for 3 months after surgical thoracolumbar fracture stabilization. Given the lack of clinical or biomechanical evidence for this, and the additional costs and potential discomfort to patients, further investigation is warranted to determine when and if POB for surgically stabilized thoracolumbar fractures is indicated. Controlled studies should include a careful analysis of pseudoarthrosis and complication rates.

KW - Brace

KW - Fracture

KW - Orthosis

KW - Orthotic

KW - Spine

KW - Trauma

UR - http://www.scopus.com/inward/record.url?scp=84977263397&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84977263397&partnerID=8YFLogxK

U2 - 10.1016/j.wneu.2016.05.067

DO - 10.1016/j.wneu.2016.05.067

M3 - Article

VL - 93

SP - 221

EP - 228

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

ER -