The Impact of Postoperative Lumbar Bracing on Patient-Reported Outcomes in Short-Segment Lumbar Fusion.

Abstract

The efficacy and indications of postoperative bracing devices following lumbar fusion remain controversial among spine surgeons. This study aims to assess the effect of bracing patient-reported outcome measures (PROMs) following short-segment lumbar fusion surgeries. A retrospective analysis of patients from a single tertiary referral care center who underwent 1-2 level posterior lumbar decompression and fusion or transforaminal lumbar interbody fusion with or without bracing between 2015 and 2020 was performed. Patient demographics, surgical characteristics, 2-year revision rates, and PROMs were collected. PROMs were collected at baseline and at 3, 6, and 12 months postoperatively. Collected PROMs include visual analog scale (VAS) for back/leg pain, Oswestry Disability Index, and the Short Form Health Survey (SF-12) Physical Component Scores and Mental Component Scores (MCS) 12. A total of 170 patients were identified (87 brace, 83 patients no brace). There was no significant difference between braced and nonbraced cohorts in 2-year revision rates for pseudoarthrosis (1.1% vs. 1.2%, P = 1.000) or 90-day readmissions (1.1% vs. 1.2%, P = 1.000). On bivariate analysis, there were no significant differences in postoperative Oswestry Disability Index, VAS-Back, VAS-Leg, or Physical Component Score 12 scores at any time point. Patients treated with bracing demonstrated a significantly higher 1-year MCS-12 score (52 vs. 48, P = 0.032). On multivariate regression, bracing did not independently predict change in any PROM at 3 or 6 months. At 1 year, bracing predicted improved MCS-12 scores (β = 5.1, P = 0.044). Postoperative bracing following 1-2 level posterior lumbar decompression and fusion and transforaminal lumbar interbody fusion surgery did not improve PROMs for pain, disability, and physical function. The isolated improvement in MCS-12 1 year postoperatively may represent a chance finding or a potential psychosomatic comfort but might not justify the physical and financial burden of bracing in this patient population.