Prospective study of orthotic use after operative stabilization of traumatic thoracic and lumbar fractures

Abstract

Background: Bracing in the postoperative setting after satisfactory operative stabilization of a traumatic thoracic or lumbar fracture is currently the accepted practice. The custom molded thoracic lumbar spine orthosis brace is generally considered the optimal postoperative brace, with the surgeon left to determine exactly how long the patient should use the brace. The aim of this study is to support the hypothesis that not only can the length of the bracing period be safely reduced but thoracic lumbar sacral orthosis (TLSO) bracing itself may not be necessary to obtain satisfactory stability. Method: A total of 138 consecutive patients were followed postoperatively for a 2-year period. Only patients with unstable traumatic injuries to the spine were studied. After the fractures were stabilized operatively, the patients were mobilized in a brace, either a TLSO or Jewett, for a 4-week period. After discontinuation of the brace, each patient completed rehabilitation and was followed for 2 years after surgery. Results: There were a total of 3 patients who lost fixation or reduction, which is an overall complication rate of 2.2%. The patients who lost fixation were injured at the T6, T12, and L1 levels. The patient injured at L1 lost both reduction and fixation and was braced for 30 days in a TLSO. There were 6 patients who received no postoperative bracing (secondary to obesity); there were no complications related to hardware in this group. Conclusion: There is a low incidence of complications related to hardware with an abbreviated postoperative bracing period. Lack of prolonged immobilization with a spinal orthosis does not alter the outcome after operative stabilization wherein proper surgical techniques were used in patients with healthy spines prior to their injury; furthermore, there is a similar complication rate with Jewetts and TLSOs. © 2006 Thomas Land Publishers, Inc.