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Bracing of patients after fusion for degenerative problems of the lumbar spine—yes or no?

updated

Tags: back pain, pain problems, spine

Two articles on PainSci cite Connolly 1998: (1) Complete Guide to Low Back Pain(2) Spinal Fracture Bracing

PainSci summary of Connolly 1998: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

This research is really just asking two experienced surgeons their opinion on the value of bracing after back surgery (for non-traumatic back problems). They disagree. “Dr. Connolly argues that an external orthosis is advisable in many cases; Dr. Grob feels that the rigidity of internal fixation should be adequate to obviate the need for external bracing.”

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

The majority of spine fusions currently performed are for degenerative conditions. Controversy exists regarding whether to routinely brace patients during the postoperative period. The benefits of a rigid orthosis have yet to be documented in a scientific study, and the cost of a custom-molded orthosis can be quite high. An extensive literature search reveals few articles dealing with the subject, and none with an adequate study design to convincingly support or refute the use of external braces. In addition to the questions of whether an external brace is effective, the mechanism of action also remains unclear. It has been difficult to document mechanical effectiveness, so perhaps the effect is psychologic. In addition, it is possible that some, not all, fusion patients may benefit from a brace--yet our ability to select such a patient is poor. As a result, we have solicited the views of two experienced surgeons on the topic. Dr. Connolly argues that an external orthosis is advisable in many cases; Dr. Grob feels that the rigidity of internal fixation should be adequate to obviate the need for external bracing.

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