Short-Term Impact of Bracing in Multi-Level Posterior Lumbar Spinal Fusion

Ryan Dimentberg; Saurabh Sinha; Gregory Glauser; Ian F Caplan; James M Schuster; Scott D McClintock; Jang W Yoon; Paul J Marcotte; Zarina S Ali; Neil R Malhotra

doi:10.14444/8119

Short-Term Impact of Bracing in Multi-Level Posterior Lumbar Spinal Fusion

Int J Spine Surg. 2021 Oct;15(5):915-920. doi: 10.14444/8119. Epub 2021 Sep 22.

Authors

Affiliations

¹ University of Pennsylvania Perelman School of Medicine, Department of Neurological Surgery, Philadelphia, Pennsylvania.
² West Chester University, Department of Mathematics and West Chester Statistical Institute, West Chester, Pennsylvania.
³ Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, Pennsylvania.

PMID: 34551926
PMCID: PMC8651189
DOI: 10.14444/8119

Abstract

Background: Clinical practice in postoperative bracing after posterior lumbar spine fusion (PLF) is inconsistent between providers. This paper attempts to assess the effect of bracing on short-term outcomes related to safety, quality of care, and direct costs.

Methods: Retrospective cohort analysis of consecutive patients undergoing multilevel PLF with or without bracing (2013-2017) was undertaken (n = 980). Patient demographics and comorbidities were analyzed. Outcomes assessed included length of stay (LOS), discharge disposition, quality-adjusted life years (QALY), surgical-site infection (SSI), total cost, readmission within 30 days, and emergency department (ED) evaluation within 30 days.

Results: Amongst the study population, 936 were braced and 44 were not braced. There was no difference between the braced and unbraced cohorts regarding LOS (P = .106), discharge disposition (P = .898), 30-day readmission (P = .434), and 30-day ED evaluation (P = 1.000). There was also no difference in total cost (P = .230) or QALY gain (P = .740). The results indicate a significantly lower likelihood of SSI in the braced population (1.50% versus 6.82%, odds ratio = 0.208, 95% confidence interval = 0.057-0.751, P = .037). There was no difference in relevant comorbidities (P = .259-1.000), although the braced cohort was older than the unbraced cohort (63 versus 56 y, P = .003).

Conclusion: Bracing following multilevel posterior lumbar fixation does not alter short-term postoperative course or reduce the risk for early adverse events. Cost analysis show no difference in direct costs between the 2 treatment approaches. Short-term data suggest that removal of bracing from the postoperative regimen for PLF will not result in increased adverse outcomes.

Keywords: cost-effectiveness; lumbar fusion; multi-level bracing; outcomes; posterior lumbar spine fusion (PLF); quality improvement.