Effectiveness of lumbar orthoses in low back pain: Review of the literature and our results

Schott, Cordelia; Zirke, Sonja; Schmelzle, Jillian Marie; Kaiser, Christel; Fernández, Lluis Aguilar I

doi:10.4081/or.2018.7791

Cited by 15 publications

(14 citation statements)

References 29 publications

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“…When no specific diagnosis is given (group B) and nonspecific orthotic treatment is administered (group D), no consistent result can be expected. The listed prospective studies ([1,6,8,11,14,17-19], Table 1) and review articles ( [12,13,15,16,24,26,27], Table 2) demonstrated no positive effect. An effect was described in three biomechanical studies ( [3,4,7], Table 1) and one postoperative study [21].…”

Section: Overview Of the Current Literaturementioning

confidence: 99%

“…All meta-analyses and literature research reviewed did not provide medical or technical differentiation [1,6,8,[11][12][13][14][15][16][17][18][19]24,26,27]. Thus, general orthotic designations such as "lumbar support" are used in the following.…”

Section: Overview Of the Current Literaturementioning

confidence: 99%

“…With effect [10] Group C Diagnosis based Orthosis Without effect [29] Group B Specific diagnosis is not given With effect -Group D Orthosis as unspecific treatment Without effect [12,13,15,16,24,26,27]…”

Section: Group a According To Specific Diagnosismentioning

confidence: 99%

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An Indication-Based Concept for Stepwise Spinal Orthosis in Low Back Pain According to the Current Literature

Landauer

Trieb

2022

JCM

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Background: The current literature is not conclusive for spinal orthosis treatment in low back pain. Therefore, two questions have to be answered: Does the current literature support the indication of spinal orthosis treatment in low back pain? Which treatment concept can be derived from the result? Method: The 30 highest-rated literature citations (PubMed: best match, 30 December 2021) dealing with low back pain and spine orthosis were included in the study. Excluded were all articles related to Kinesio Taping, scoliosis, physical exercise, or dealing with side effects and unrelated to treatment effect. Thus, the literature list refers only to “low back pain and spine orthoses”. These articles were analyzed according to the PRISMA criteria and divided according to “specific diagnosis”, when the cause of pain was explained (group A), or when “specific diagnosis is not given” (group B). The articles were also distinguished by the information about the orthosis. Articles with biomechanical information about the function of the orthoses were called “diagnosis-based orthosis” (group C). All other articles were part of the group “unspecific orthotic treatment” (group D). The results were compared to each other in terms of effectiveness. According to anatomical causes, a concept of orthosis selection depending on diagnosis of low back pain for clinical practice was developed. The risk of bias lies in the choice of the MESH terms. The synthesis of the results was a clinical treatment concept based on findings from the current literature. Results: The literature citations with 1749 patients and 2160 citations of literature were processed; 21 prospective clinical or biomechanical studies and 9 review articles were included. The combination of literature citations according to “specific diagnosis” (group A) and “diagnosis based orthosis” (group C) was very likely to lead to a therapeutic effect (seven articles). No positive effect could be found in four articles, all dealing with postoperative treatment. When “specific diagnosis is not given” (group B) and combined with “unspecific orthotic treatment” (group D), therapy remained without measurable effect (15 articles). An effect was described in four articles (three biomechanical studies and one postoperative study). In review articles, according to specific diagnosis, only one article dealt with fractures and another with stenosis. In all review articles where specific diagnosis was not given, no effect with spine orthoses could be found. Using this knowledge, we created a clinical treatment concept. The structure was based on diagnosis and standardized orthoses. According to pain location and pathology (muscle, intervertebral disc, bone, statics, postoperative) the orthoses were classified to anatomical extent and the mechanical limitation (bandage, bodice, corset, orthosis with shoulder straps and erecting orthosis). Conclusion: The effectiveness of spinal orthoses could not be deduced from the current literature. The most serious limitation was the inconsistency of the complaint and the imprecise designation of the orthoses. Interpretation: Articles with a precise allocation of the complaint and a description of the orthosis showed a positive effect. The treatment concept presented here is intended to provide a basis for answering the question concerning the effectiveness of spinal orthoses as an accompanying treatment option in low back pain.

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Section: Overview Of the Current Literaturementioning

confidence: 99%

Section: Overview Of the Current Literaturementioning

confidence: 99%

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An Indication-Based Concept for Stepwise Spinal Orthosis in Low Back Pain According to the Current Literature

Landauer

Trieb

2022

JCM

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“…Compelling theoretical and observational evidence for the benefit of postoperative external immobilization exists [ [1] , [2] , [3] – 4 ]. However, the clinical utility of postoperative orthoses has long been questioned [ 1 , 5 , 6 ], and clinical series have failed to show improvement in patient outcomes with their use [ [6] , [7] – 8 ]. Surgeon usage of postoperative bracing has thus been mixed [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Postoperative bracing practices after elective lumbar spine surgery: A questionnaire study of U.S. spine surgeons

Pathak

Scott

Galivanche

et al. 2021

North American Spine Society Journal (NASSJ)

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Background: There is limited data available on the use of orthoses across varying elective spine surgeries. When previously studied in 2009, inconsistent lumbar postoperative bracing practices were reported. The present study aimed to provide a ten-year update regarding postoperative bracing practices after elective lumbar surgery among United States (U.S.) spine surgeons.Methods: A questionnaire was distributed to attendees of the Lumbar Spine Research Society Annual Meeting (April 2019). The questionnaire collected demographic information, and asked surgeons to identify if they used orthoses postoperatively after ten elective lumbar surgeries. Information regarding type of brace, duration of use, and reason for bracing was also collected. Chi-square tests and one-way analysis of variance (ANOVA) were used for comparisons.Results: Seventy-three of 88 U.S. attending surgeons completed the questionnaire (response rate: 83%). The majority of respondents were orthopaedic surgery-trained (78%), fellowship-trained (84%), and academic surgeons (73%). The majority of respondents (60%) did not use orthoses after any lumbar surgery. Among the surgeons who braced, the overall bracing frequency was 26%. This rate was significantly lower than that reported in the literature ten years earlier ( p < 0.0001). Respondents tended to use orthoses most often after stand-alone lateral interbody fusions (43%) ( p < 0.0001). The average bracing frequency after lumbar fusions (34%) was higher than the average bracing frequency after non-fusion surgeries (16%) ( p < 0.0001). The most frequently utilized brace was an off the shelf lumbar sacral orthosis (66%), and most surgeons braced patients to improve pain (42%). Of surgeons who braced, most commonly did so for 2-4 months (57%). Conclusion:Most surgeon respondents did not prescribe orthoses after varying elective lumbar surgeries, and the frequency overall was lower than a similar study conducted in 2009. There continues to be inconsistencies in postoperative bracing practices. In an era striving for evidence-based practices, this is an area needing more attention.

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“…Long term orthotic bracing is a very common nonsurgical therapy for the treatment of spine diseases [1,2]. Although there is evidence for the use of physiotherapy to address moderate spinal deformities, such as idiopathic scoliosis, brace treatment is preferred, often in combination with scoliosis specific daily rehabilitation, especially during the pubertal growth spurt [3,4].…”

Section: Introductionmentioning

confidence: 99%

3D printing orthopedic scoliosis braces: a test comparing FDM with thermoforming

Redaelli

Abbate

Storm

et al. 2020

Int J Adv Manuf Technol

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In recent years, 3D printing gained considerable attention in the orthopedic sector. This work evaluates the feasibility of producing orthopedic scoliosis braces by 3D printing, comparing performance and costs with classical thermoforming procedures. Critical parameters, such as manufacture time, mechanical properties, weight, and comfort are carefully considered. Polyethylene terephthalate glycol-modified (PETG) was selected among the several filaments materials present on the market. Printed samples were analyzed with electronic microscope, tensile, and impact tests and compared with thermoformed polyethylene (PE) and polypropylene (PP) samples. Moreover, a cost analysis was carried out for the specific application. The thermoformed brace of a volunteer patient affected by scoliosis was reproduced using reverse-engineering techniques. The model was then printed as a single piece and postprocessed by an expert orthotist. Subsequently, the patient wore the brace in a pilot case to compare comfort and mechanical effectiveness. Results show that the 3D printing fabrication method is able to provide a valid alternative to the current fabrication methods, being also very competitive in terms of costs. The morphological analysis does not show critical defects in 3D printed samples, while the mechanical tests highlighted their anisotropy, with an overall brittleness of PETG samples in the direction orthogonal to the fibers. However, in terms of mechanical stresses, a back brace should never reach the polymer yield stress, otherwise the shape would be modified and the therapeutic effect could be compromised. Finally, the patient reported the perception of improved support and no significant comfort differences compared with the thermoformed brace.

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Effectiveness of lumbar orthoses in low back pain: Review of the literature and our results

Cited by 15 publications

References 29 publications

An Indication-Based Concept for Stepwise Spinal Orthosis in Low Back Pain According to the Current Literature

An Indication-Based Concept for Stepwise Spinal Orthosis in Low Back Pain According to the Current Literature

Postoperative bracing practices after elective lumbar spine surgery: A questionnaire study of U.S. spine surgeons

3D printing orthopedic scoliosis braces: a test comparing FDM with thermoforming

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