Evaluation of postoperative bracing on unstable traumatic lumbar fractures after pedicle screw fixation.

Abstract

Background: Fractures of the thoracolumbar and lumbar regions are very important. There is still debate on the use of braces after surgical operations. The current study aims to evaluate and report the outcomes of postoperative bracing following pedicle screw fixation in patients with thoracolumbar and lumbar fractures in Iran.

Methods: This is a clinical trial performed from 2012 to 2022 on 144 patients diagnosed with lumbar and thoracolumbar fractures. Demographic data of patients including age and gender were obtained. Patients' fractures were classified as Frankel (A to E) in terms of clinical and neurological manifestations. Patient's quality of life (QOL) was measured using the 36-Item Short Form Survey (SF-36). All patients underwent surgical fixation of the fracture. Patients were then randomized into two groups using Random Allocation Software. The first group received post-operation bracing and the second group did not receive braces. Thus, radiographic and clinical evaluation data of 1, 3, and 12 months after surgery were used to determine bone fusion.

Results: The most common mechanisms of trauma included falling from a height in 99 patients (68.7%), vehicle accidents in 39 patients (27.1%), and the most common fracture sites were the L1 vertebrae in 73 patients (50.7%), 111 patients (77.1%) had burst fractures, and 105 patients (72.3%) had no neurological defects (Frankel E). At the beginning of the study, there were no significant differences between the two groups regarding the mentioned data, patients' QOL, and pain severity. All patients (100%) had early mobilization. Most patients (85.4%) did not report persistent back pain 12 months after surgeries. 90.2% returned to their daily activities and all patients (100%) had full fusion based on radiologic data. The QOL and pain severity of patients improved significantly compared to baseline (P < 0.001 for both).

Conclusion: The use or non-use of braces did not affect the treatment results. As a result, patients who have received pedicle screw fixation for unstable thoracolumbar fractures do not require braces in the postoperative period.