Motivation: I have never worn body armor, but a thoracolumbar brace looks close to it. I often see the full body brace clipped onto elderly women after a compression fracture of the spine from a fall, and I wonder if it actually does anything besides making for a closeted experience. Although there are many practices in surgery without evidence, turns out that this idea has actually been tested in a single randomized trial.
Paper: Stadhouder, A., Buskens, E., Vergroeen, DA, et. al. "Nonoperative treatment of thoracic and lumba spine fractures: a prospective randomized study of different treatment options." J Orthop. Trauma (2009); 23: 588.
Methods: Randomized trial carried out in Amsterdam. Patients younger than 80 with traumatic thoracic or lumbar compresssion fractures ( less than 50% disc height loss or 30% spinal canal stenosis) without neurological impairment were randomized to (1) physical therapy for 6 weeks, (2) removable brace for 6 weeks, or (3) plaster of paris cast for 6 or 12 weeks. No single primary outcome pre-specified. Parameters followed included radiographic improvement, pain measure, and disability index meaurd at 6 weeks, 12 weeks, 6 months, and 12 months.
Results:
Cohort: Total of 108 patient were randomized with 54.1% women with mean age of 45. Baseline measurements such as gender distribution, age, and admission time were similar among groups. Majority of patients had high-energy trauma.
Tolerability: For compression fractures, physical therapy was better tolerated than plaster of paris but not significantly different than brace therapy. Brace therapy was also better tolerated than plaster of paris therapy.
Residual Pain: At long term follow-up (1 year later), visual analogue scale residual pain was significantly less for brace compared to plaster of paris therapy for 12 weeks (mean difference 19.0, CI: 1.87-36.2). There was no difference between physical therapy and brace therapy or between brace therapy and cast for 6 weeks.
Disability Index: At long term follow-up, measure by Owestry Disability Index, brace therapy for 6 weeks was superior to physical therapy (mean difference 14.9, CI: 2.7-27.1) and cast for 12 weeks (mean difference 10.1, CI: 0.25-25.0) or 6 weeks.
Discussion: I think that this paper represents one of the many cases in medicine where an exploratory trial of limited power has been generalized to a wide population. The patients in the trial were primarily in their 40s presenting after a high-impact accident. These patients are clearly different than the elderly patients with osteoporotic compression fractures encountered in clinical practice. Moreover, the trial itself suffers from several notable flaws with perhaps the lack of a pre-specified primary outcome being the most significant one. Even for the significant outcomes, the confidence intervals are very wide. While a brace makes pathophyiological sense for treating fractures, the treatment choice for compression fractures remains an area of uncertainty.
Paper: Stadhouder, A., Buskens, E., Vergroeen, DA, et. al. "Nonoperative treatment of thoracic and lumba spine fractures: a prospective randomized study of different treatment options." J Orthop. Trauma (2009); 23: 588.
Methods: Randomized trial carried out in Amsterdam. Patients younger than 80 with traumatic thoracic or lumbar compresssion fractures ( less than 50% disc height loss or 30% spinal canal stenosis) without neurological impairment were randomized to (1) physical therapy for 6 weeks, (2) removable brace for 6 weeks, or (3) plaster of paris cast for 6 or 12 weeks. No single primary outcome pre-specified. Parameters followed included radiographic improvement, pain measure, and disability index meaurd at 6 weeks, 12 weeks, 6 months, and 12 months.
Results:
Cohort: Total of 108 patient were randomized with 54.1% women with mean age of 45. Baseline measurements such as gender distribution, age, and admission time were similar among groups. Majority of patients had high-energy trauma.
Tolerability: For compression fractures, physical therapy was better tolerated than plaster of paris but not significantly different than brace therapy. Brace therapy was also better tolerated than plaster of paris therapy.
Residual Pain: At long term follow-up (1 year later), visual analogue scale residual pain was significantly less for brace compared to plaster of paris therapy for 12 weeks (mean difference 19.0, CI: 1.87-36.2). There was no difference between physical therapy and brace therapy or between brace therapy and cast for 6 weeks.
Disability Index: At long term follow-up, measure by Owestry Disability Index, brace therapy for 6 weeks was superior to physical therapy (mean difference 14.9, CI: 2.7-27.1) and cast for 12 weeks (mean difference 10.1, CI: 0.25-25.0) or 6 weeks.
Discussion: I think that this paper represents one of the many cases in medicine where an exploratory trial of limited power has been generalized to a wide population. The patients in the trial were primarily in their 40s presenting after a high-impact accident. These patients are clearly different than the elderly patients with osteoporotic compression fractures encountered in clinical practice. Moreover, the trial itself suffers from several notable flaws with perhaps the lack of a pre-specified primary outcome being the most significant one. Even for the significant outcomes, the confidence intervals are very wide. While a brace makes pathophyiological sense for treating fractures, the treatment choice for compression fractures remains an area of uncertainty.
My father in law has been suffering from back pain since 6 years and he is a Grocery business man. For this reason he has to sit in his chair for a long time. After using back brace he feels comfort.. So I think it is a great way to reducing pain. This article has shown this. Thank you.
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