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Postoperative Bracing on Pain, Disability, Complications, and Fusion Rate Following 1-3+ Level Lumbar Fusion in Degenerative Conditions: A Meta-Analysis.

OBJECTIVES
Lumbar fusion surgeries in degenerative spinal conditions can be invasive and may challenge the normal biomechanical spine and joint function. Frequently, patients require postoperative rehabilitation management. The purpose of this meta-analysis is to determine if there is an advantage to using a postoperative lumbar orthosis with regard to postoperative function and surgical healing.


DATA SOURCES
Articles in the English language were searched in electronic databases including PubMed and Clinicaltrials.gov from January 1, 2004 to January 1, 2019.


STUDY SELECTION
Studies were included if they were described as being a prospective randomized trial, utilized a common pain score determinant, reported complications postoperatively, analyzed disability, and were published within a 15-year period. After review of 218 citations by 2 authors, 4 studies were identified as meeting the inclusion criteria.


DATA EXTRACTION
Pain scores (Visual Analogue Scale/Dallas Pain Questionnaire), disability (Oswestry Disability Index, Short Form-36, Roland-Morris Disability Questionnaire), postoperative complications and fusion rate outcomes were collected.


DATA SYNTHESIS
Four prospective randomized controlled trials were identified and met the inclusion criteria. The outcome disability level showed a combined effect differed from 0 and favored the control [g=0.26, 95% confidence interval (CI): 0.04-0.49, P=0.029]. Visual Analogue Scale pain's combined effect did not differ from 0 and did not favor either the control or brace group (g=0.01, 95% CI: -0.25 to 0.27, P=0.93). The odds ratio (ORs) for complication rates did not differ from 1 (OR=0.88, 95% CI: 0.47-1.65, P=0.69). There was no significant difference in the ORs for fusion rate. Study heterogeneity was measured for all outcomes and there was no excessive variation.


CONCLUSIONS
The present meta-analysis indicated no significant difference in pain scores, a decrease in disability level for control (no brace), no significant change in fusion rate, and no significant difference in the odds of complication for the brace group. These conclusions support the theory that there is no significant advantage of postoperative lumbar orthoses.