Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(02): 333-337
DOI: 10.4103/ajns.AJNS_35_20
Original Article

Evaluation of lumbar spine bracing as a postoperative adjunct to single-level posterior lumbar spine surgery

Saurabh Sinha
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
,
Ian Caplan
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
,
James Schuster
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
,
Matthew Piazza
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
2   Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, PA
,
Gregory Glauser
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
,
Nikhil Sharma
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
,
William Welch
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
,
Benjamin Osiemo
3   Department of Neurosurgery, University of Pennsylvania
4   Department of Mathematics, West Chester Statistical Institute, West Chester University, Philadelphia, PA
,
Scott Mcclintock
4   Department of Mathematics, West Chester Statistical Institute, West Chester University, Philadelphia, PA
,
Ali Ozturk
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
,
Neil Malhotra
1   Department of Neurological Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
2   Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, PA
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Background: Clinical practice in postoperative bracing after posterior single-level lumbar spine fusion (PLF) is inconsistent between providers. This study seeks to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs. Methods: Retrospective cohort analyses of consecutive patients undergoing single-level PLF with or without bracing at a three-hospital urban academic medical center (2013–2017) were undertaken (n = 906). Patient demographics and comorbidities were analyzed. Test of independence, Mann–Whitney–Wilcoxon test, and logistic regression were used to assess differences in length of stay (LOS), discharge disposition/need for postacute care, quality-adjusted life year (QALY), surgical site infection (SSI), hospital cost, total cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results: Among the study population, 863 patients were braced and 43 were not braced. No difference was seen between the two groups in short-term outcomes from surgery including LOS (P = 0.836), discharge disposition (P = 0.226), readmission (P = 1.000), ER visits (P = 0.281), SSI (P = 1.000), and QALY gain (P = 0.319). However, the braced group incurred a significantly higher direct hospital cost (median increase of 41.43%, P < 0.001) compared to the unbraced cohort (bracing cost excluded). There was no difference in graft type (P = 0.145) or comorbidities (P = 0.20–1.00) such as obesity (P = 1.000), smoking (P = 1.000), chronic obstructive pulmonary disease (P = 1.000), hypertension (P = 0.805), coronary artery disease (P = 1.000), congestive heart failure (P = 1.000), and total number of comorbidities (P = 0.228). Conclusion: Short-term data suggest that removal of bracing from the postoperative regimen for PLF will not result in increased adverse outcomes but will reduce cost.

Key-words:

Lumbar fusion - posterior lumbar spine fusion - single-level bracing

Financial support and sponsorship

Nil.




Publication History

Received: 29 January 2020

Accepted: 16 March 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Fritzell P, Hägg O, Wessberg P, Nordwall A; Swedish Lumbar Spine Study Group. Chronic low back pain and fusion: A comparison of three surgical techniques: A prospective multicenter randomized study from the Swedish lumbar spine study group. Spine (Phila PA 1976) 2002;27:1131-41.
  • 2 Bjarke Christensen F, Stender Hansen E, Laursen M, Thomsen K, Bünger CE. Long-term functional outcome of pedicle screw instrumentation as a support for posterolateral spinal fusion: Randomized clinical study with a 5-year follow-up. Spine (Phila PA 1976) 2002;27:1269-77.
  • 3 Bible JE, Biswas D, Whang PG, Simpson AK, Rechtine GR, Grauer JN. Postoperative bracing after spine surgery for degenerative conditions: A questionnaire study. Spine J 2009;9:309-16.
  • 4 Elsenbeck MJ, Wagner SC, Milby AH. Is routine bracing of benefit following posterior instrumented lumbar fusion for degenerative indications? Clin Spine Surg 2018;31:363-5.
  • 5 Nachemson A, Morris JM.In vivo measurements of intradiscal pressure. Discometry, a method for the determination of pressure in the lower lumbar discs. J Bone Joint Surg Am 1964;46:1077-92.
  • 6 Skoch J, Zoccali C, Zaninovich O, Martirosyan N, Walter CM, Maykowski P, et al. Bracing After surgical stabilization of thoracolumbar fractures: A systematic review of evidence, indications, and practices. World Neurosurg 2016;93:221-8.
  • 7 Soliman HA, Barchi S, Parent S, Maurais G, Jodoin A, Mac-Thiong JM. Early Impact of postoperative bracing on pain and quality of life after posterior instrumented fusion for lumbar degenerative conditions: A randomized trial. Spine (Phila Pa 1976) 2018;43:155-60.
  • 8 Caplan I, Sinha S, Schuster J, Piazza M, Glauser G, Osiemo B, et al. The utility of cervical spine bracing as a postoperative adjunct to single-level anterior cervical spine surgery. Asian J Neurosurg 2019;14:461-6.
  • 9 Yee AJ, Yoo JU, Marsolais EB, Carlson G, Poe-Kochert C, Bohlman HH, et al. Use of a postoperative lumbar corset after lumbar spinal arthrodesis for degenerative conditions of the spine. A prospective randomized trial. J Bone Joint Surg Am 2008;90:2062-8.
  • 10 Agabegi SS, Asghar FA, Herkowitz HN. Spinal orthoses. J Am Acad Orthop Surg 2010;18:657-67.
  • 11 Gawande AA. Why Doctors Hate Their Computers. The New Yorker; 2018 Nov 12.
  • 12 Rohlmann A, Bergmann G, Graichen F, Neff G. Braces do not reduce loads on internal spinal fixation devices. Clin Biomech (Bristol, Avon) 1999;14:97-102.
  • 13 Jegede KA, Miller CP, Bible JE, Whang PG, Grauer JN. The effects of three different types of orthoses on the range of motion of the lumbar spine during 15 activities of daily living. Spine (Phila Pa 1976) 2011;36:2346-53.