Postoperative spinal orthosis may not be necessary for minimally invasive lumbar spine fusion surgery: a prospective randomized controlled trial

Abstract

Background With the progress and success in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF), the musculoskeletal injury was minimized. However, the role of postoperative orthosis in MIS TLIF has not been established and there is little evidence supporting the routine use of orthosis in MIS TLIF. Methods This is a prospective randomized clinical study. 90 patients who underwent MIS TLIF were randomly divided into groups A (with postoperative spinal orthosis) and B (without postoperative spinal orthosis). Patients were followed up for an average of 12.6 months. Clinical outcome was assessed using the Oswestry disability index (ODI) and visual analogue scale (VAS). Fusion rate was classified with the BSF scale system at postoperative 6-month, and 12-month. Results Both groups had similar patient demographics. The use of postoperative spinal orthosis had no significant influence on instrumentation-related complications or radiological parameters at each follow-up. Conclusions In this study, we conclude that postoperative spinal orthosis is not necessary for MIS TLIF. Patients without postoperative spinal orthosis had the same fusion rates and improvement of VAS and ODI scores.

Development of multidisciplinary, evidenced-based protocol recommendations and implementation strategies for anterior lumbar interbody fusion surgery following a literature review

“…Recent RCTs involving patients undergoing minimally invasive transforaminal lumbar interbody fusion and posterior spinal fusion concluded that spinal orthosis is not necessary after surgery. [213,215,216] Patients without orthosis had similar fusion rates, pain scores, and disability index scores. Moreover, eliminating back braces altogether resulted in a more comfortable postoperative period, an easier recovery, and higher patient satisfaction.…”

“…It is also used for restricting the movement of an operated spine. [213] The pain following spine surgery is typically less severe when an external brace is applied due to the increased stability offered by the brace and the increased sense of security that it gives to patients. [214] However, there is no consistent scientific evidence to support the routine use of a postoperative lumbar brace.…”

Postoperative Spinal Orthoses: Types and Outcomes

“…It also illustrates the change in behaviors with newer surgical techniques as modern instrumentation has become adopted and proven reliable for fixation. 2,22 Surgeons should weigh the risks and benefits of bracing with emphasis on the individual characteristics of each patient. These include the intended mechanism of the orthotic device, biomechanics, patient compliance, and cost of the orthosis.…”

What’s New in Spine Surgery

“…Lastly, Ma et al performed a prospective randomized trial evaluating the utility of postoperative spinal orthoses after MIS-TLIF 35 . The authors found that the use of a postoperative orthosis had no significant effect on the Oswestry Disability Index (ODI) or visual analog scale pain score at 6 or 12 months after MIS-TLIF.…”