Mary P Zhu1, Lindsay A Tetreault2, Fatimah Sorefan-Mangou3, Philip Garwood3, Jefferson R Wilson4. 1. Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, Ontario M5B 1W8, Canada. 2. Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst St, Toronto, Ontario M5T 2S8, Canada; Graduate Entry Medicine, School of Medicine, University College Cork, Brookfield, College Rd, Cork, T12 K8AF, Ireland. 3. Graduate Entry Medicine, School of Medicine, University College Cork, Brookfield, College Rd, Cork, T12 K8AF, Ireland. 4. Division of Neurosurgery, Department of Surgery, St. Michael's Hospital, University of Toronto, 30 Bond St, Toronto, Ontario M5B 1W8, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, 209 Victoria St, Toronto, Ontario M5B 1T8, Canada. Electronic address: wilsonjeff@smh.ca.
Abstract
BACKGROUND CONTEXT: Bracing is often used after spinal surgery to immobilize the spine, improve fusion, and relieve pain. However, controversy exists regarding the efficacy, necessity, and safety of various bracing techniques in the postsurgical setting. PURPOSE: In this systematic review, we aimed to compare the effectiveness, safety, and cost-effectiveness of postoperative bracing versus no postoperative bracing after spinal surgery in patients with several common operative spinal pathologies. STUDY DESIGN/ SETTING: A systematic review was carried out to compare postoperative bracing and no postoperative bracing. METHODS: A systematic search was conducted of MEDLINE, Embase, and the Cochrane Collaboration Library from 1970 to May 2017, supplemented by manual searching of the reference list of relevant studies and previously published reviews. Studies were included if they compared disability, quality of life, functional impairment, radiographic outcomes, cost-effectiveness, or complications between patients treated with postoperative bracing and patients not receiving any postoperative bracing. Each article was critically appraised independently by two reviewers, and the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS: Of the 858 retrieved citations, 5 studies met the inclusion criteria and were included in this review, consisting of 4 randomized controlled trials and 1 prospective cohort study. Low to moderate evidence suggests that there are no significant differences in most measures of disability, pain, quality of life, functional impairment, radiographic outcomes, and safety between groups. Isolated studies reported statistically significant and inconsistent differences between groups with respect to Neck Disability Index at 6 weeks postoperatively or Short Form-36 Physical Component Score at 1.5, 3, 6, and 12 months postoperatively. CONCLUSIONS: Based on limited evidence, postoperative bracing does not result in improved outcomes after spinal surgery. Future high-quality randomized trials will be required to confirm these findings.
BACKGROUND CONTEXT: Bracing is often used after spinal surgery to immobilize the spine, improve fusion, and relieve pain. However, controversy exists regarding the efficacy, necessity, and safety of various bracing techniques in the postsurgical setting. PURPOSE: In this systematic review, we aimed to compare the effectiveness, safety, and cost-effectiveness of postoperative bracing versus no postoperative bracing after spinal surgery in patients with several common operative spinal pathologies. STUDY DESIGN/ SETTING: A systematic review was carried out to compare postoperative bracing and no postoperative bracing. METHODS: A systematic search was conducted of MEDLINE, Embase, and the Cochrane Collaboration Library from 1970 to May 2017, supplemented by manual searching of the reference list of relevant studies and previously published reviews. Studies were included if they compared disability, quality of life, functional impairment, radiographic outcomes, cost-effectiveness, or complications between patients treated with postoperative bracing and patients not receiving any postoperative bracing. Each article was critically appraised independently by two reviewers, and the overall body of evidence was rated using guidelines outlined by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) Working Group. RESULTS: Of the 858 retrieved citations, 5 studies met the inclusion criteria and were included in this review, consisting of 4 randomized controlled trials and 1 prospective cohort study. Low to moderate evidence suggests that there are no significant differences in most measures of disability, pain, quality of life, functional impairment, radiographic outcomes, and safety between groups. Isolated studies reported statistically significant and inconsistent differences between groups with respect to Neck Disability Index at 6 weeks postoperatively or Short Form-36 Physical Component Score at 1.5, 3, 6, and 12 months postoperatively. CONCLUSIONS: Based on limited evidence, postoperative bracing does not result in improved outcomes after spinal surgery. Future high-quality randomized trials will be required to confirm these findings.
Authors: Ryan Dimentberg; Saurabh Sinha; Gregory Glauser; Ian F Caplan; James M Schuster; Scott D McClintock; Jang W Yoon; Paul J Marcotte; Zarina S Ali; Neil R Malhotra Journal: Int J Spine Surg Date: 2021-09-22
Authors: Ian F Caplan; Saurabh Sinha; Benjamin Osiemo; Scott D McClintock; James M Schuster; Harvey Smith; Gregory Glauser; Nikhil Sharma; Ali K Ozturk; Zarina S Ali; Neil R Malhotra Journal: Int J Spine Surg Date: 2020-04-30
Authors: Ian Caplan; Saurabh Sinha; James Schuster; Matthew Piazza; Gregory Glauser; Benjamin Osiemo; Scott McClintock; William C Welch; Nikhil Sharma; Ali Ozturk; Neil Rainer Malhotra Journal: Asian J Neurosurg Date: 2019 Apr-Jun
Authors: Neil Pathak; Michelle C Scott; Anoop R Galivanche; Patrick J Burroughs; Harold G Moore; Ari S Hilibrand; Rohil Malpani; Marissa Justen; Arya G Varthi; Jonathan N Grauer Journal: N Am Spine Soc J Date: 2021-02-27