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Effects of Bracing on Clinical and Radiographic Outcomes Following Thoracolumbar Burst Fractures in Neurologically Intact Patients

A Meta-Analysis of Randomized Controlled Trials

Wallace, Nicholas MD1; McHugh, Michael MD1; Patel, Rakesh MD1; Aleem, Ilyas S. MD, MSc, FRCSC1

doi: 10.2106/JBJS.RVW.19.00006
Evidence-Based Systematic Reviews
Supplementary Content

Background: We conducted a meta-analysis of randomized trials to determine the effect of the use of an orthosis (as compared with no orthosis) on clinical and radiographic outcomes in neurologically intact patients with thoracolumbar burst fractures. Optimal nonoperative treatment of thoracolumbar burst fractures in neurologically intact patients remains inconclusive. Conventional care prescribes spine precautions and a thoracolumbar orthosis. Recent studies have suggested that patients with stable burst fractures can obtain comparable outcomes with or without bracing.

Methods: We performed a comprehensive search of the literature with use of OVID MEDLINE, Embase, and the Cochrane Library. Two independent reviewers assessed the eligibility of studies and the risk of bias of included trials. We analyzed several outcomes: the Roland Morris Disability Questionnaire (RMDQ) score, Oswestry Disability Index (ODI), Short Form-36 Physical and Mental Component Summary (SF-36 PCS and MCS) scores, pain, length of stay, treatment failure, and kyphotic angle. We used weighted mean differences and standardized mean differences in a random-effects model.

Results: We included 3 studies with a total of 59 patients who were managed with use of a brace and 60 patients who were managed without a brace. There was no significant difference between groups treated with or without an orthosis in terms of SF-36 PCS, SF-36 MCS, RMDQ/ODI, pain, length of stay, failure rates, or kyphosis angle at baseline or 6-month follow-up. Similar outcomes were seen at long-term follow-up of ≥5 years.

Conclusions: This meta-analysis suggests that neurologically intact patients with thoracolumbar burst fractures obtain similar clinical and radiographic outcomes with or without bracing at both short and long-term follow-up. Routine use of orthoses following these fractures may incur substantial costs and patient morbidity without clinical benefit.

Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

1Division of Spine Surgery, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan

E-mail address for I.S. Aleem:

Investigation performed at the Division of Spine Surgery, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan

Disclosure: The authors indicated that no external funding was received for any aspect of this work. The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (

Copyright © 2019 by The Journal of Bone and Joint Surgery, Incorporated
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