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Bracing After Spine Surgery: Is It Really Needed?
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Posted on: 11/30/1999
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Spine surgeons (both orthopedic and neurosurgeons) often use bracing for their patients after fusion of the neck or low back. But with today's evidence-based practice, there's been a question about this practice. Is it really needed? Is there any evidence to support external immobilization of this type? Or is it just a matter of doing what we've always done because we've always done it?
The authors of this study set out to see what are the bracing patterns of spine surgeons. They developed a one-page questionnaire and gave it to surgeons attending a Disorders of the Spine conference in Canada. The survey asked what type of procedures the surgeon performed and whether or not bracing was used postoperatively for each operation.
Type of brace (soft, hard, custom-made, off-the-shelf, corset) and length of use were also recorded. A separate column of questions on reasons for bracing (e.g., increase fusion rate, reduce pain, restrict patient activity) was also part of the questionnaire.
And a little bit of information about the surgeon was collected. Type of surgeon, practice setting, education, number of years in clinical practice, and location were biographical questions analyzed. They looked at each surgical decision made in relation to the surgeon's background.
What they found was that no matter what background, the frequency of bracing was about the same. That was true whether the surgeon was in an academic vs. private practice setting and regardless of the number of years of experience. There were some slight differences based on whether the surgeon had completed a spine fellowship. The more highly trained fellows were more likely to use bracing. Bracing was also more common among surgeons in the United States compared to surgeons practicing in other countries.
Bracing was used more often following cervical (neck) fusions, especially when more than one-level was involved. It didn't seem to matter what type of fusion was done (anterior vs. posterior, with or without internal fixation). As for how long bracing was used, surgeons agreed that they used bracing for three weeks or less in cases of a single-level cervical fusion. Longer periods of immobilization were used for multi-level fusions. Soft collars were used for single-level fusions. Rigid collars were more common for complicated and multilevel surgeries.
When bracing was used for the lumbar spine, it was discontinued earlier when rods were used internally to hold the spine in place during the healing/fusion process. Surgeons reported using a canvas-material corset for lumbar spine procedures that didn't involve fusion. Rigid bracing was used more often for fusion procedures. It didn't appear to matter whether or not a custom-made brace was used versus an off-the-shelf model.
The results of this study show there is continued reason to doubt the need for postoperative bracing after spinal fusion. There's no evidence that bracing really prevents motion of the fused vertebral segments. Likewise, there's no support for the idea that bracing slows the patient down, reduces pain, or improves the fusion rate. There are risks associated with wearing a brace such as nerve palsies, difficulty breathing or swallowing (neck brace), and skin reactions.
It is the opinion of some surgeons that proper surgical technique and the use of rigid internal fixation (rods, screws, metal plates) to hold the spine in place should be enough. The bone will fill in and create a solid fusion without the support of an external brace.
The authors point out the need for valid studies to prove this assumption. On the flip side, studies are needed to show that bracing improves outcomes. If bracing is found to be effective, details of when to use them, with which patients, and for how long will need to be answered as well.
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References:
Jesse E. Bible, BS, et al. Postoperative Bracing After Spine Surgery for Degenerative Conditions: A Questionnaire Study. In The Spine Journal. April 2009. Vol. 9. No. 4. Pp. 309-316.
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