Copyright © 2008 by The Journal of Bone and Joint Surgery, Inc.
Commentary & Perspective
Commentary & Perspective by
Edward N. Hanley Jr., MD*,
Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina
Posted October 2008
Bracing and casting are becoming treatment tools of the
past. Internal fixation to achieve spinal fusion, joint arthrodesis, and
fracture care is universally employed. I am unaware of a surgical fusion
procedure having been performed without instrumentation in well over a decade. Along
with the use of internal fixation, there has been a movement away from postoperative
bracing. Clinical experience suggests that it makes very little difference whether
a patient is managed postoperatively with or without a brace. Some patients are
uncomfortable or feel claustrophobic in a brace, while others like the sense of
support and security in the early postoperative period.
The authors of this prospective randomized trial
investigated the use of a corset after lumbar spinal arthrodesis with internal
fixation and provided us with Level-I evidence that there is little reason to
employ this regimen to improve long-term outcomes.
The outcome with regard to pain, function, and general
physical health measures was no different between the study group and the
control group. Both groups improved substantially, whether they were treated
with a supplementary corset or not. Fusion rates were not affected by the use
of a corset.
However, although this study was well designed to assess the
effects of postoperative use of a corset with regard to a follow-up time of two
years, it fails to address the potential short-term benefits of this device. My
clinical experience is that early use of a brace presents a potential benefit in
early postoperative pain control and more rapid mobilization in the hospital. A
study needs to be done to address whether use of a corset reduces use of pain
medication in the early period after surgery. In the meantime, I will continue
to fit my patients with a corset on a selective basis after lumbar fusion and will
tell patients that, while it won't affect their long-term outcome, it might
help them be more comfortable and secure and leave the hospital earlier after
surgery1.
*The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.
References
1. Connolly PJ, Grob D. Bracing of patients after fusion for degenerative problems of the lumbar spine--yes or no? Spine. 1998;23:1426-8.
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