The Journal of Bone and Joint Surgery (American). 2008;90:2062-2068.
doi:10.2106/JBJS.G.01093
© 2008 The Journal of Bone and Joint Surgery, Inc.
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Use of a Postoperative Lumbar Corset After Lumbar Spinal Arthrodesis for Degenerative Conditions of the Spine

A Prospective Randomized Trial

A.J. Yee, MD, FRCS(C)1, J.U. Yoo, MD2, E.B. Marsolais, MD3, G. Carlson, MD5, C. Poe-Kochert, CNP4, H.H. Bohlman, MD4 and S.E. Emery, MD6

1 The Spine Program, Division of Orthopaedic Surgery, Sunnybrook Health Sciences Centre, Department of Surgery, University of Toronto, 2075 Bayview Avenue, Room MG 371-B, Toronto, ON M4N 3M5, Canada. E-mail address: Albert.Yee{at}sunnybrook.ca
2 Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Road, Portland, OR 97239-3098
3 1611 South Green Road, South Euclid, OH 44121
4 Department of Orthopaedic Surgery, University Hospitals Spine Institute, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106
5 Orthopaedic Specialty Institute, Medical Group of Orange County, 850-1140 West La Veta Avenue, Orange, CA 92868
6 Department of Orthopaedics, West Virginia University, 1 Medical Center, Morgantown, WV 26506
Investigation performed at the Spine Institute, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio

Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from Medtronic Sofamor Danek. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Medtronic Sofamor Danek) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM/DVD (call our subscription department, at 781-449-9780, to order the CD-ROM or DVD).

Background: Lumbosacral corsets and braces have been used to treat a variety of spinal disorders. Although their use after lumbar arthrodesis for degenerative conditions has been reported, there is a lack of evidence on which to base guidelines on their use. The purpose of this study was to evaluate the effect of a postoperative corset on the outcome of lumbar arthrodesis.

Methods: A prospective randomized trial was performed in which patients who wore a postoperative lumbar corset for eight weeks full-time after a posterior lumbar arthrodesis for a degenerative spinal condition were compared with those who did not use a corset after such an operation. Ninety patients were randomized to one of the two treatments. A history was recorded and patients were assessed with a physical examination, radiographs, and functional outcome questionnaires (the Dallas Pain Questionnaire [DPQ] and the Short Form-36 [SF-36]) preoperatively and at one year and two years following the surgery. The primary outcome measure of the study was the DPQ, a disease-specific patient-derived functional measure of the spine, and secondary end points included the SF-36 scores, complications, rates of fusion as determined radiographically, and reoperation rates.

Results: Follow-up analysis was performed for seventy-two patients, thirty-seven randomized to the brace (experimental) group and thirty-five randomized to the control group. Regardless of the treatment method, the patients had substantial improvement in the disease-specific and general health measures by two years postoperatively. At two years, there was no difference in the DPQ category scores (the primary outcome parameter) of the two treatment groups. There was also no difference in the mean SF-36 component scores at two years. Postoperative complications occurred in 22% and 23% of patients in the experimental and control groups, respectively, and a subsequent lumbar spinal operation was performed in 19% and 14%, respectively. Seven patients (five in the experimental group and two in the control group) with radiographic evidence of nonunion underwent revision surgery.

Conclusions: This study does not indicate a significant advantage or disadvantage to the use of a postoperative lumbar corset following spinal arthrodesis for degenerative conditions of the lumbar spine.

Level of Evidence: Therapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.


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