Introduction: While frequently prescribed to patients following fixation for spine trauma, the utility of spinal orthoses during the post-operative period is poorly described in the literature. In this study, we calculated rates of re-operation and performed a decision analysis to determine the utility of bracing following pedicle screw fixation for thoracic and lumbar vertebral fractures.
Methods: Pubmed was searched for articles published between 2005 and 2015 for terms related to pedicle screw fixation of thoracolumbar fractures. Additionally, a database of neurosurgical patients operated on within the University of Pennsylvania Health System (UPHS) was also used in the analysis. Incidences of significant adverse events (wound revision for either dehiscence or infection or re-operation for non-union or instability due to hardware failure) were determined. Pooled means and variances of reported parameters were obtained using a random-effects, inverse variance meta-analytic model for observational data. Utilities for surgical outcome and complications were assigned using previously published values.
Results: Of the 225 abstracts reviewed, 56 articles were included in the study, yielding a total of 2180 patients. After including patients from the UPHS registry, together a total of 2304 patients were included in the final analysis, 1480 of whom were braced. Non-braced patients were significantly older than braced patients (40.1±6.2 vs. 45.6±9.5, p=0.01). Braced vs. non-braced patients had similar rates of re-operation for non-union or hardware failure (1.7%±2.0% vs. 1.5%±1.3%, p=0.687), although non-braced patients trended toward a greater rate of wound complications (2.9%±2.5% vs. 4.3%±2.4%, p=0.082). These two approaches yielded comparable utility scores (p=0.860).
Conclusions: Bracing following operative stabilization of thoracolumbar fracture does not significantly improve stability, nor does it increase wound complications.
Patient Care: This study suggests that not bracing post-operatively after spinal fixation for thoracolumbar fractures may be equally as effective as bracing. Not bracing post-operatively in this population may lead to lower health care costs and greater patient satisfaction.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the impact of bracing on re-operation rates after spinal fixation for thoracolumbar fractures, and 2) discuss the overall utility of post-operative bracing following spinal fixation for thoracolumbar fractures