Bracing of patients after fusion for degenerative problems of the lumbar spine--yes or no?

The majority of spine fusions currently performed are for degenerative conditions. Controversy exists regarding whether to routinely brace patients during the postoperative period. The benefits of a rigid orthosis have yet to be documented in a scientific study, and the cost of a custom-molded orthosis can be quite high. An extensive literature search reveals few articles dealing with the subject, and none with an adequate study design to convincingly support or refute the use of external braces. In addition to the questions of whether an external brace is effective, the mechanism of action also remains unclear. It has been difficult to document mechanical effectiveness, so perhaps the effect is psychologic. In addition, it is possible that some, not all, fusion patients may benefit from a brace--yet our ability to select such a patient is poor. As a result, we have solicited the views of two experienced surgeons on the topic. Dr. Connolly argues that an external orthosis is advisable in many cases; Dr. Grob feels that the rigidity of internal fixation should be adequate to obviate the need for external bracing.