No evidence for the effectiveness of bracing in patients with thoracolumbar fractures

Abstract

Background and purpose The use of braces is widespread in patients with thoracolumbar fractures. The effectiveness of bracing, however, is controversial. We sought evidence for the effect of bracing in patients with traumatic thoracolumbar fractures based on outcome and length of hospital stay (LOS). Furthermore, we evaluated the incidence of complications of bracing.Methods An electronic search strategy with extensive MeSH headings was used in various databases to identify studies that compared bracing and non-bracing therapies. Two reviewers independently selected systematic reviews, randomized controlled trials (RCTs), controlled clinical trials, and observational studies, and both assessed the methodological quality and extracted the data.Results No systematic reviews or RCTs were found. 7 retrospective studies were included. None of these studies showed an effect of bracing. Because of poor methodological quality, no best-evidence synthesis could be performed. One observational study was selected in which a complication of bracing was reported.Interpretation In the present literature, there is no evidence for the effectiveness of bracing in patients with traumatic thoracolumbar fractures. The lack of high-quality studies prevents relevant conclusions from being drawn.

The effects of orthosis on thoracolumbar fracture healing: A review of the literature

“…Various parameters have been used to represent the severity of fracture and also the effects of orthosis including: neurological status, canal compromise, ability to return to work, severity of pain, kyphosis angulations, complication, rate of remodeling, narrowing, vertebral height reduction and vertebral alignment. 5,7,8,10,12,13,[16][17][18][19][20][21][22] …”

“…It should be emphasized that the role orthosis is a combination of support, rest, immobilization, protection, correction and reminding. 12 Based on the results of various studies, the role of orthosis for fracture of spine would be mostly immobilization, protection and reminding. 12 …”

“…12 Based on the results of various studies, the role of orthosis for fracture of spine would be mostly immobilization, protection and reminding. 12 …”

“…30 In contrast Giele et al concluded that there is no evidence to show the effectiveness of bracing in patients with traumatic thoracolumbar fracture. 12 As it was mentioned before, most of these review articles are on comparison of brace and surgery. Therefore, it can be concluded that the present study is the first review done in this regard which clearly shows that the use of orthosis influences the outcome of treatment and reduces pain in patients with a stable fracture in thoracolumbar spine.…”

“…12,13 Similarly, Ohana et al confirmed that there is no evidence to support the positive influence of brace on treatment of fracture in the lumbosacral region, therefore, this type of fracture should be treated with early ambulation and with no external support. 10 In contrast, Celebi et al in their study on 26 individuals, recognized with single burst type fracture, showed that the average pain score in patients with spinal fracture decreased follow the use of orthoses.…”