Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials

Study Design:Systematic literature review with meta-analysis.Objective:Thoracolumbar (TL) fractures can be treated conservatively or surgically. Especially, the treatment strategy for incomplete and complete TL burst fractures (A3 and A4, AOSpine classification) in neurologically intact patients remains controversial. The aim of this work was to collate the clinical evidence on the respective treatment modalities.Methods:Searches were performed in PubMed and the Web of Science. Clinical and radiological outcome data were collected. For studies comparing operative with nonoperative treatment, the standardized mean differences (SMD) for disability and pain were calculated and methodological quality and risk of bias were assessed.Results:From 1929 initial matches, 12 were eligible. Four of these compared surgical with conservative treatment. A comparative analysis of radiological results was not possible due to a lack of uniform reporting. Differences in clinical outcomes at follow-up were small, both between studies and between treatment groups. The SMD was 0.00 (95% CI −0.072, 0.72) for disability and −0.05 (95% CI −0.91, 0.81) for pain. Methodological quality was high in most studies and no evidence of publication bias was revealed.Conclusions:We did not find differences in disability or pain outcomes between operative and nonoperative treatment of A3 and A4 TL fractures in neurologically intact patients. Notwithstanding, the available scores have been developed and validated for degenerative diseases; thus, their suitability in trauma may be questionable. Specific and uniform outcome parameters need to be defined and enforced for the evaluation of TL trauma.

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“… 9 Fewer reviews have been published about conservative treatment options, for example, on the usefulness of orthoses. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?

Rometsch

Spruit

Härtl

et al. 2017

Global Spine Journal

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“…Multiple prior studies have demonstrated the lack of benefit associated with bracing for stable TL fractures, and this study did not aim to replicate those findings. 7,9,11,14 In this study, providers were not compelled to follow the pathway, and fracture stability determination and treatment was ultimately up to their clinical judgment. A greater degree of change may have been observed had we been more stringent in our efforts to ensure compliance with the pathway.…”

Section: Discussionmentioning

confidence: 99%

Reducing Radiation and Lowering Costs With a Standardized Care Pathway for Nonoperative Thoracolumbar Fractures

Hanson

Lyons

Fournier

et al. 2019

Global Spine Journal

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Study Design:Retrospective observational study.Objective:There is marked variation in the management of nonoperative thoracolumbar (TL) compression and burst fractures. This was a quality improvement study designed to establish a standardized care pathway for TL fractures treated with bracing, and to then evaluate differences in radiographs, length of stay (LOS), and cost before and after the pathway.Methods:A standardized pathway was established for management of nonoperative TL burst and compression fractures (AOSpine classification type A1-A4 fractures). Bracing, radiographs, costs, complications, and LOS before and after pathway adoption were analyzed. Differences between the neurosurgery and orthopedic spine services were compared.Results:Between 2012 and 2015, 406 nonoperative burst and compression TL fractures were identified. A total of 183 (45.1%) were braced, 60.6% with a custom-made thoracolumbosacral orthosis (TLSO) and 39.4% with an off-the-shelf TLSO. The number of radiographs significantly reduced after initiation of the pathway (3.23 vs 2.63, P = .010). A total of 98.6% of braces were custom-made before the pathway; 69.6% were off-the-shelf after the pathway. The total cost for braced patients after pathway adoption decreased from $10 462.36 to $8928.58 (P = .078). Brace-associated costs were significantly less for off-the-shelf TSLO versus custom TLSO ($1352.41 vs $3719.53, respectively, P < .001). The mean LOS and complication rate did not change significantly following pathway adoption. The orthopedic spine service braced less frequently than the neurosurgery service (40.7% vs 52.2%, P = .023).Conclusions:Standardized care pathways can reduce cost and radiation exposure without increasing complication rates in nonoperative management of thoracolumbar compression and burst fractures.

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“…Patients are encouraged to apply the spinal brace at all times unless they are lying down, for example, during bedrest. Typically, these braces are usually fixed and rigid (for example, TLSO, thoracolumbar spinal orthosis, see Figure 3 ) [ 21 ].…”

Section: Passive Spine Braces In the Treatment Of Osteoporotic Spimentioning

confidence: 99%

Review of Current Spinal Robotic Orthoses

Mak

Accoto

2021

Healthcare

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Osteoporotic spine fractures (OSF) are common sequelae of osteoporosis. OSF are directly correlated with increasing age and incidence of osteoporosis. OSF are treated conservatively or surgically. Associated acute pain, chronic disabilities, and progressive deformities are well documented. Conservative measures include a combination of initial bed rest, analgesia, early physiotherapy, and a spinal brace (orthosis), with the aim for early rehabilitation to prevent complications of immobile state. Spinal bracing is commonly used for symptomatic management of OSF. While traditional spinal braces aim to maintain the neutral spinal alignment and reduce the axial loading on the fractured vertebrae, they are well known for complications including discomfort with reduced compliance, atrophy of paraspinal muscles, and restriction of chest expansion leading to chest infections. Exoskeletons have been developed to passively assist and actively augment human movements with different types of actuators. Flexible, versatile spinal exoskeletons are designed to better support the spine. As new technologies enable the development of motorized wearable exoskeletons, several types have been introduced into the medical field application. We have provided a thorough review of the current spinal robotic technologies in this paper. The shortcomings in the current spinal exoskeletons were identified. Their limitations on the use for patients with OSF with potential improvement strategies were discussed. With our current knowledge of spinal orthosis for conservatively managed OSF, a semi-rigid backpack style thoracolumbar spinal robotic orthosis will reduce spinal bone stress and improve back muscle support. This will lead to back pain reduction, improved posture, and overall mobility. Early mobilization is an important part of management of patients with OSF as it reduces the chance of developing complications related to their immobile state for patients with OSF, which will be helpful for their recovery.

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Orthosis for thoracolumbar burst fractures without neurologic deficit: A systematic review of prospective randomized controlled trials

Cited by 24 publications

References 32 publications

Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?

Does Operative or Nonoperative Treatment Achieve Better Results in A3 and A4 Spinal Fractures Without Neurological Deficit?

Reducing Radiation and Lowering Costs With a Standardized Care Pathway for Nonoperative Thoracolumbar Fractures

Review of Current Spinal Robotic Orthoses

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