<p>Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture</p>

Abstract

Background An important goal in the treatment of osteoporotic vertebral compression fractures (OVCFs) is the prevention of new vertebral fractures and the subsequent progression to global sagittal malalignment. Current conservative treatment is multimodal and comprises analgesics, medication for osteoporosis, and physical therapy. However, little is known about the value of orthoses in the treatment of OVCFs. Aims The primary purpose of this study was to examine the direct effect of a semirigid thoracolumbar orthosis on gait in patients suffering from an OVCF. The secondary purpose was to evaluate changes in gait, radiographic sagittal alignment, pain, and quality of life over time. Methods Fifteen postmenopausal patients with an OVCF were treated with a semirigid thoracolumbar orthosis. At baseline, after 6 weeks, and after 6 months, gait analysis was performed with a dual belt–instrumented treadmill with a 180° projection screen providing a virtual environment (computer-assisted rehabilitation environment) combined with clinical and radiographic assessments. Results At baseline, bracing caused a significantly more upright posture during walking and patients walked faster, with larger strides, longer stride times, and lower cadence compared to walking without orthosis. After 6 weeks, radiographic and dynamic sagittal alignment had improved compared to baseline. The observed effect was gone after 6 months, when the orthosis was not worn anymore. Conclusion A semirigid thoracolumbar orthosis seems to have a positive effect on gait and stability in patients suffering from an OVCF, as was shown by a more upright posture, which may result in decreased compressive loading of the vertebrae. For studying the true effectiveness of dynamic bracing in the treatment of OVCFs, a prospective, randomized controlled trial will be needed.

Experiences of using an activating spinal orthosis in women with osteoporosis and back pain in primary care

“…One explanation could be that the individual felt steadier and more confident and that it took longer for back fatigue to set in. This explanation is partially supported by a qualitative study showing that walking ability was improved for older individuals with thoracic kyphosis who used an activating spinal orthosis, as well as a study in which a spinal orthosis was used in rehabilitation after a vertebral fracture [ 25 , 26 ]. The experiences of the interviewees were also supported by a study that showed that training of the back extensor muscles played an important role in relieving back pain, preventing the development of kyphosis and making it easier to perform daily activities for individuals with osteoporosis and back pain, with a vertebral fracture [ 2 , 3 ].…”

“…In our study, it was found that women seeking primary care usually benefitted from an activating spinal orthosis as a treatment for their condition. In several quantitative studies involving the use of an activating spinal orthosis, the findings indicated increased back muscle strength, reduced back pain and reduced thoracic kyphosis, improved balance and walking ability, as well as improved health-related quality of life [ 13 , 25 , 26 , 28 , 29 ]. Increased back extensor strength can also prevent future vertebral fractures [ 6 , 7 ].…”

Effectiveness of orthoses for treatment in patients with spinal pain

“…Jacobs et al [32] assessed 15 patients with an osteoporotic vertebral compression fracture. Following the use of a semirigid TLSO for 6 weeks, their VAS scores and quality of life (measured using the Quality of Life Questionnaire of the European Foundation for Osteoporosis) were evaluated.…”

The Role of Spinal Orthoses in Osteoporotic Vertebral Fractures of the Elderly Population (Age 60 Years or Older): Systematic Review

“…The type of orthosis studied and further characteristics are summarized in Table 3. Shariatzadeh et al, 201 6 20 Jacobs et al, 201 9 21 Li et al, 201 5 22 Valentin et al, 201 3 23 Vogt et al, 200 8 24 Dionyssiotis et al, 201 5 25 Kim et al, 201 4 26 Talic et al, 201 2 27 Non-osteoporotic vertebral fractures…”