Postoperative bracing after lumbar surgery: a survey amongst spinal surgeons in Belgium

Abstract

Bracing is frequently prescribed following lumbar surgery for degenerative conditions. However, previous studies failed to demonstrate advantage of postoperative lumbar bracing in both short and long term outcome in terms of pain, quality of life and fusion rate. The purpose of this study was to assess the prescription patterns and rationale for postoperative bracing among spinal surgeons in Belgium.Methods: A 16-item online-survey was distributed by email to spinal surgeons affiliated to the Spine Society of Belgium (N= 252).Results: A total of 105 surgeons (42%) completed the survey. The overall bracing frequency following lumbar surgery was 38%. A brace was more often prescribed following fusion procedures (52%) than after non-fusion procedures (21%) (p< 0.0001). The majority of surgeons (59%) considered bracing after at least one type of lumbar surgery. Orthopaedic surgeons (73%) reported a significantly higher rate of prescribing postoperative bracing compared to neurosurgeons (44%) (p= 0.003). Pain alleviation (67%) was the main goal for prescribing a postoperative brace. A total of 42% of the surgeons aimed to improve fusion rate by bracing after lumbar fusion procedures. A quasi-equal level of the scientific literature (29%), personal experience (35%) and teaching from peers (36%) was reported to contribute on the attitudes towards prescribing bracing. Conclusions:Postoperative bracing was prescribed by Belgian spinal surgeons following more than one third of lumbar procedures. This was underpinned by beliefs regarding pain alleviation and higher fusion rate. Interestingly, based on the scientific literature these beliefs have been demonstrated to be false.

The efficacy of postoperative bracing after spine surgery for lumbar degenerative diseases: a systematic review

“…Despite limited evidence to support its efficacy, the use of bracing after surgery for a variety of lumbar spine conditions remains relatively common and widespread between surgeons [5,6]. Pain relief was the main reason provided for prescribing postoperative bracing, followed by a desire to improve the rate of fusion, in a recent European survey on the use of bracing after lumbar surgery [6]. However, these assumptions were based on the personal experience, beliefs, and training of spine surgeons rather than on current evidence in the literature [6][7][8][9][10][11][12].…”

“…Low There were no differences between the brace group and the control group with respect to the rates of fusion seen radiographically at 12 months (p = 0.8) or 24 months (p = 0.9) postoperatively Interbody fusion after TLIF evaluated by CT at the 6-and 12-month postoperative follow-up using the Brantigan-Steffee-Fraser BSF classification [3] 90 (1 [3]) review failed to find differences in disability and pain levels between the bracing treatment and control groups after lumbar surgery [1][2][3][4]. The use of postoperative bracing has been advocated by several surgeons after non-fusion surgery to prevent incipient instability and related symptoms, including low back pain and disability [4][5][6]. The theoretical mechanisms associated with a reduction in disability and pain after lumbar decompression surgery include a decrease in intervertebral motion, a decrease in the amount of biomechanical loading on the area of the spine undergoing surgery, and enhanced support of the musculoskeletal system [9].…”

“…The use of bracing following various types of surgery for lumbar degenerative disease is common, and it extends to fusion procedures, as well as microdiscectomy and laminectomy [1][2][3][4]. Postoperative bracing was, respectively, prescribed for 49% and 38% of the patients in two surveybased studies in North America and Europe following lumbar procedures [5,6]. The theoretical advantages of bracing include a reduction in intervertebral motion and biomechanical loading on the area of the spine undergoing surgery, with a subsequent supposed improvement in functional outcomes and rate of fusion (e.g.…”

“…Accordingly, consensus remains lacking on the necessity of postoperative bracing after surgery for lumbar degenerative disc disease, and the debate on this continues. Neurosurgeons frequently prescribe postoperative bracing based on their experience and training rather than on current evidence in the literature [5,6].…”

Comparison of the Effectiveness of Three Lumbosacral Orthoses on Early Spine Surgery Patients: A Prospective Cohort Study

“…The traditional decompression and fusion procedure of the lumbar spine has been steadily increasing recently, and postoperative bracing (lumbosacral orthosis [LSO]) is commonly used after surgical treatment of lumbar degenerative conditions [1][2][3]. A previous study showed that 56%-59% of surgeons routinely consider postoperative bracing after at least one type of lumbar procedure [4,5]. An LSO is used to reduce pain and employed as a nonsurgical treatment of the spine by immobilizing a motion segment and unloading the forces on that spine segment by serving as a kinesthetic reminder and elevating intraabdominal pressure [6,7].…”