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Treatment Outcomes in Osteoporotic Compression Fractures: Brace or No-Brace?
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Posted on: 11/30/1999
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Non-operative treatment is usually the first line of treatment for benign compression fractures of osteoporotic vertebrae without neurological injury. These fractures are relatively stable secondary to the nature of the injury occurring from a compressional load versus involving shearing or rotational components. Typically this non-operative treatment has included the use of bracing as well as pain management. In theory braces have been utilized to provide stabilization to the injured site which facilitates alignment, early mobility and protecting it from further collapse. Some noted disadvantages of bracing include muscular atrophy from disuse, skin irritation and deconditioning. A recent research article looked to compare improvements in disability and pain in patients with osteoporotic compression fractures who were treated with the use of rigid, soft or no brace.
In total sixty patients were included in the study and underwent randomization and baseline assessment being allocated to the rigid-brace group, soft-brace group or no-brace group. Patients whom were allotted to the rigid-brace group were ordered on strict bed-rest until an appropriate rigid brace could be fit and applied. The soft-braces were ready made and thus could be utilized immediately upon patient enrollment in the study. In the two brace wearing groups patients were instructed to wear the brace at all times except when lying down. They were instructed to wear the braces for eight weeks. Patients in the no-brace group were instructed to walk without any brace as long as they were comfortable. All participants took pain medication as necessary and were educated on restricting spine movement, heavy lifting and carrying without a specific weight limit during the initial eight weeks. After the eight weeks, a two-week weaning period occurred. The primary outcome measure utilized was a baseline adjusted Oswestry Disability Index (ODI) at twelve-week post compression fracture injury. Secondary measures included pain ratings on Visual Analog Scale (VAS), ODI score, progression of the compression ratio over follow-up visits, general health status, and treatment satisfaction. Baseline characteristics were similar among all participant regardless of grouping. Every participant had one vertebral fracture located from T7 to L3 vertebrae.
The baseline adjusted ODI score at twelve weeks in the non-brace wearing group was not inferior in comparison to the soft-brace or rigid brace group. This primary outcome score was 35.95 points in the no-brace group compared to 37.83 and 33.53 points respectively in the soft-brace and rigid-brace groups, demonstrating a predetermined margin of noninferiority (an ODI score of ten points). There was no statistical difference found in any of the secondary outcome categories. The ODI scores and VAS scores for back pain significantly improved with time in all three groups. Additionally the body compression ratios significantly decreased with time in all three groups. Patient satisfaction in treatment as well as general health status did not differ between the three groups. The authors concluded that treatment without a brace for benign osteoporotic compression fractures did not result in inferior outcomes in patient disability as compared to use of rigid or soft-brace treatments.
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References:
Ho-Joong Kim, MD, et al. Comparative Study of the Treatment Outcomes of Osteoporotic Compression Fractures without Neurologic Injury Using a Rigid Brace, a Soft Brace, and No Brace. The Journal of Bone and Joint Surgery. December 2014. Vol. 96-A. No 23. Pp 1959-1966.
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