Bracing After Surgical Stabilization of Thoracolumbar Fractures: A Systematic Review of Evidence, Indications, and Practices.
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.
Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA. Electronic address: jesse.skoch@cchmc.org.
Jesse
J
Skoch
Oncological Orthopaedics Department, Muscular-Skeletal Tissue Bank, IFO-Regina Elena National Cancer Institute, Rome, Italy.
Carmine
C
Zoccali
Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA.
Orel
O
Zaninovich
Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA.
Nikolay
N
Martirosyan
Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA.
Christina M
CM
Walter
Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA.
Philip
P
Maykowski
Division of Neurosurgery, Banner University Medical Center, Tucson, Arizona, USA.
Ali A
AA
Baaj
D001915:Braces / Q000706:statistics & numerical data*; D015984:Causality; D015897:Comorbidity; D005260:Female; D005593:Fracture Fixation, Internal / Q000534:rehabilitation* / Q000706:statistics & numerical data*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011542:Pseudarthrosis / Q000453:epidemiology / Q000517:prevention & control; D020127:Recovery of Function; D012307:Risk Factors; D016103:Spinal Fractures / Q000453:epidemiology* / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000293:injuries*; D016896:Treatment Outcome
Brace; Fracture; Orthosis; Orthotic; Spine; Trauma