Efficacy, safety and economics of bracing after spine surgery: a systematic review of the literature

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Zhu, Mary P.
Tetreault, Lindsay A.
Sorefan-Mangou, Fatimah
Garwood, Philip
Wilson, Jefferson R.
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Elsevier Inc.
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Background Context: Bracing is often used after spinal surgery to immobilize the spine, improve fusion, and relieve pain. However, controversy exists regarding the efficacy, necessity and safety of various bracing techniques in the post-surgical setting. Purpose: In this systematic review, we aimed to compare the effectiveness, safety and cost-effectiveness of postoperative bracing versus no postoperative bracing following spinal surgery in patients with several common operative spinal pathologies. Study Design/Setting: Systematic Review. Patient Sample: N/A. Outcome Measures: N/A. Methods: A systematic search was conducted of MEDLINE, Embase and the Cochrane Collaboration Library from 1970 to May 2017, supplemented by manual searching of the reference list of relevant studies and previously published reviews. Studies were included if they compared disability, quality of life, functional impairment, radiographic outcomes, cost-effectiveness and/or complications between patients treated with postoperative bracing versus those not receiving any postoperative bracing. Each article was critically appraised independently by 2 reviewers, and the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group.Results: Of the 858 retrieved citations, 5 studies met inclusion criteria and were included in this review, consisting of 4 randomized controlled trials and 1 prospective cohort study. Low to moderate evidence suggests that there are no significant differences in most measures of disability, pain, quality of life, functional impairment, radiographic outcomes, and safety between groups. Isolated studies reported statistically significant and inconsistent differences between groups with respect to Neck Disability Index at 6 weeks postoperatively and/or Short Form-36 Physical Component Score at 1.5, 3, 6, and 12 months postoperatively. Conclusions: Based on limited evidence, postoperative bracing does not result in improved outcomes following spinal surgery. Future high quality randomized trials will be required to confirm these findings.
Outcomes , Postoperative bracing , Surgery , Spinal pathology , Complications
Zhu, M. P., Tetreault, L. A., Sorefan-Mangou, F., Garwood, P. and Wilson, J. R. (2018) ‘Efficacy, safety and economics of bracing after spine surgery: a systematic review of the literature’, Spine Journal, 18(9), pp. 1513-1525. doi: 10.1016/j.spinee.2018.01.011.