Postoperative bracing after spine surgery for degenerative conditions: a questionnaire study

Background context: A variety of orthoses are routinely applied after spinal procedures but there are limited data regarding their efficacy, especially with the increasing use of internal fixation. At this time, the proper indications for postoperative bracing are not well established. Purpose: To assess the postoperative bracing patterns of spine surgeons. Study design/setting: Questionnaire study. Patient sample: Spine surgeons attending the "Disorders of the Spine" conference (January 2008, Whistler, Canada). Outcome measures: Frequencies of bracing after specific surgical procedures. Methods: A single-page questionnaire was distributed to all spine surgeons attending the "Disorders of the Spine" conference (January 2008). The questionnaire focused on whether surgeons typically immobilize patients after specific spinal procedures, the type of orthosis used, the duration of treatment, and the rationale for bracing. Results: Ninety-eight of 118 surgeons completed the survey (response rate: 83%). The frequency of bracing was similar between academic and private as well as orthopedic and neurosurgical practices. The difference in the bracing tendencies of fellowship and non-fellowship trained surgeons was found to be statistically significant (61% vs. 46%, p<.0001). The duration of clinical experience did not appear to influence the propensity of surgeons to use orthoses. Bracing was employed more regularly after cervical spine procedures than surgeries involving the lumbar spine (63% vs. 49%, p<.0001). In the anterior cervical spine, orthoses were used more often as the complexity of the procedure increased from single to multilevel constructs (55% vs. 76%, p<.0001). The frequencies of bracing were not significantly different between noninstrumented and instrumented lumbar fusions. In most cases, bracing was continued for a total of 3-8 weeks and the restriction of patient activity was the most common reason cited by surgeons who use orthoses. Conclusions: Although most of the respondents brace their patients postoperatively, there is an obvious lack of consensus regarding the most appropriate type, duration, and indications for immobilization. Further prospective, clinical studies may play a helpful role in evaluating the efficacy of postoperative bracing protocols.