Copyright © 2008 by The Journal of Bone and Joint Surgery, Inc.

Commentary & Perspective

Commentary & Perspective on
"Use of a Postoperative Lumbar Corset after Lumbar Spinal Arthrodesis for Degenerative Conditions of the Spine: A Prospective Randomized Trial"
by A.J. Yee, MD, FRCS(C), et al.

Commentary & Perspective by
Edward N. Hanley Jr., MD*,
Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, North Carolina

Posted October 2008

Bracing and casting are becoming treatment tools of the past. Internal fixation to achieve spinal fusion, joint arthrodesis, and fracture care is universally employed. I am unaware of a surgical fusion procedure having been performed without instrumentation in well over a decade. Along with the use of internal fixation, there has been a movement away from postoperative bracing. Clinical experience suggests that it makes very little difference whether a patient is managed postoperatively with or without a brace. Some patients are uncomfortable or feel claustrophobic in a brace, while others like the sense of support and security in the early postoperative period.

The authors of this prospective randomized trial investigated the use of a corset after lumbar spinal arthrodesis with internal fixation and provided us with Level-I evidence that there is little reason to employ this regimen to improve long-term outcomes.

The outcome with regard to pain, function, and general physical health measures was no different between the study group and the control group. Both groups improved substantially, whether they were treated with a supplementary corset or not. Fusion rates were not affected by the use of a corset.

However, although this study was well designed to assess the effects of postoperative use of a corset with regard to a follow-up time of two years, it fails to address the potential short-term benefits of this device. My clinical experience is that early use of a brace presents a potential benefit in early postoperative pain control and more rapid mobilization in the hospital. A study needs to be done to address whether use of a corset reduces use of pain medication in the early period after surgery. In the meantime, I will continue to fit my patients with a corset on a selective basis after lumbar fusion and will tell patients that, while it won't affect their long-term outcome, it might help them be more comfortable and secure and leave the hospital earlier after surgery1.

*The author did not receive any outside funding or grants in support of his research for or preparation of this work. Neither he nor a member of his immediate family received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the author, or a member of his immediate family, is affiliated or associated.

References

1. Connolly PJ, Grob D. Bracing of patients after fusion for degenerative problems of the lumbar spine--yes or no? Spine. 1998;23:1426-8.