Orthosis in Thoracolumbar Fractures

Abstract

Study Design. Systematic review and meta-analysis of randomized controlled trial (RCT). Objective. The aim of this study was to evaluate radiological and clinical outcomes of acute traumatic thoracolumbar fractures in skeletally mature patients treated with orthosis, versus no immobilization. Summary of Background Data. Orthosis is traditionally used in conservative treatment of thoracolumbar fractures. However, recent studies suggest no benefit, and a possible negative impact in recovery. Methods. Databases were searched from inception to June 2019. Studies were selected in two phases by two blinded reviewers; disagreements were solved by consensus. Inclusion criteria were: RCT; only patients with acute traumatic thoracolumbar fractures; primary conservative treatment; comparison between orthosis and no orthosis. Exclusion criteria were inclusion of nonacute fractures, patients with other significant known diseases and comparison of groups different than use of an orthosis. Two independent reviewers performed data extraction and quality assessment. Fixed-effects models were used upon no heterogeneity, and random-effects model in the remaining cases. A previous plan for extraction of radiological (kyphosis progression; loss of anterior height) and clinical (pain; disability; length of stay) outcomes was applied. PRISMA guidelines were followed. Results. Eight articles/five studies were included (267 participants). None reported significant differences in pain, kyphosis progression, and loss of anterior height. One reported a better ODI with orthosis at 12 but not at 24 weeks. No other study reported differences in disability. All authors concluded an equivalence between treatments. Meta-analysis showed a significant increase of 3.47days (95% confidence interval 1.35–5.60) in mean admission time in orthosis group. No differences were found in kyphosis at 6 and 12 months; kyphosis progression between 0 to 6 and 0 to 12 months; loss of anterior height 0 to 6 months; VAS for pain at 6 months; VAS change 0 to 6 months. Conclusion. Orthosis seems to add no benefit in conservative treatment of acute thoracolumbar fractures. This should be considered in guidelines and reviews of health care policies. Level of Evidence: 3

Analysis of factors influencing the intravertebral shell phenomenon after posterior reduction internal fixation of thoracolumbar fracture: a retrospective study

“…Thoracolumbar segment fractures are among the most common types of spinal fractures in clinical practice [ 1 , 2 ] and account for approximately 60–70% of all spinal fractures. This is mainly attributed to their special biomechanical and anatomical characteristics [ 3 ].…”

Epidemiology and 12-Month Outcomes of Patients Managed in a Thoracolumbosacral Orthosis After Trauma

“…However, bracing is not without risk, and its overuse may lead to pressure-related skin breakdown (due to patient size, poor total contact fit, skin condition, poor compliance, or pressure due to the three-point nature of the orthosis), diminished respiratory capacity (due to the tight fitting nature of the orthosis), and weakness of the paraspinal musculature 15,18 . Recent studies have also demonstrated increased length of stay and health care costs with these devices 16 …”

“…14 Thoracolumbosacral orthoses (TLSOs) are devices that many authors suggest play a role in the healing process, diminishing the load transferred via the anterior column, limiting segmental motion, and helping in pain control. [15][16][17] However, bracing is not without risk, and its overuse may lead to pressure-related skin breakdown (due to patient size, poor total contact fit, skin condition, poor compliance, or pressure due to the three-point nature of the orthosis), diminished respiratory capacity (due to the tight fitting nature of the orthosis), and weakness of the paraspinal musculature. 15,18 Recent studies have also demonstrated increased length of stay and health care costs with these devices.…”

“…15,18 Recent studies have also demonstrated increased length of stay and health care costs with these devices. 16 The Boston Overlap Brace (BOB) is a commonly used TLSO to treat thoracolumbar fractures. The BOB is an anterior opening, semirigid thermoplastic brace to help maintain lordosis, thereby bringing more loads toward the posterior column away from the anterior and middle columns.…”