Medical Student Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, Arizona Phoenix, Arizona, United States
Introduction: With improved fixation and fusion techniques in lumbar spinal fusions, the utility of postoperative orthosis is no longer clear. Recent studies have investigated the effects of postoperative bracing on pain and fusion outcomes and failed to show a clear benefit of postoperative bracing after lumbar fusion for degenerative spine conditions. In light of this evidence, we hypothesize that the literature will demonstrate a clear trend toward decreased use of postoperative bracing in such cases.
Methods: This systematic review was performed according to PRISMA guidelines using search terms “lumbar fusion,” “PLIF,” ALIF,” “TLIF,” “PLF,” “brace,” “orthosis,” “immobilization,” “corset,” “LSO,” and “postoperative.” Non-randomized cohort studies of adult patients who underwent lumbar fusion for degenerative conditions were included if the proportion of patients prescribed postoperative orthosis was reported. Survey studies reporting spine surgeons’ preferences on the topic were also included.
Results: 147 unique entries resulted, 66 of which were reviewed in full text. Ultimately, 7 studies reported the frequency of bracing among the appropriate patient population and were included in addition to 3 pertinent survey studies. A survey of spine surgeons in in 2021 showed an overall bracing frequency of 26% compared to 49% in 2009. However, cohort studies reporting rates of bracing published between 2006 and 2020 with study periods from 2001-2018 showed no clear trend in the use of postoperative bracing.
Conclusion : The limited literature on the efficacy of postoperative bracing after lumbar fusion for degenerative conditions is insufficient to support this practice. Subjective surveys suggest a decrease in utilization of postoperative bracing for short fusion, but it remains common among more than one quarter of spine surgeons. Further, there is minimal reporting of bracing in the literature, making it impossible to accurately report objective trends in utilization. Without clear evidence or guidelines on postoperative bracing, surgeons base their decision on their training and instinct which may perpetuate the use of unnecessary medical equipment. As advancement in the technology and equipment used in spine surgery continue, a renewed focus on investigating supporting measures such as orthosis is imperative to avoid unnecessary use of resources .
