Is a Brace Necessary for Spinal Fracture Healing?

Compression fractures in the spine due to osteoporosis, a common condition causing progressive bone loss and increased fracture risk, especially are common in older women. A new study appearing in the Dec. 3 issue of the Journal of Bone & Joint Surgery found that patients who wore a brace as treatment for a spinal compression fracture had comparable outcomes in terms of pain, function and healing when compared to patients who did not wear a brace.

Nearly 700,000 men and women suffer from a spinal compression fracture annually. These fractures, which for the most part are stable fractures occurring on the front or anterior of the spine, are nearly twice as common as other fractures typically linked to osteoporosis such as broken hips and wrists.

Women are at greater risk with more than 30 percent age 70 or older suffering at least one osteoporosis-related spinal fracture. Many patients with these fractures are instructed to wear a soft or rigid brace to stabilize the spine with the intent of reducing pain and preventing further deterioration and collapse of the fracture site. However, patients often find the braces uncomfortable, and as a result, do not wear the braces consistently. In addition, prolonged use may result in muscular atrophy (muscle deterioration due to lack of use), deconditioning, skin irritation, as well as additional costs and delays in rehabilitation.

In a Korean study, 60 patients (age 65 and older) with acute osteoporotic compression fractures were randomly assigned within three days of injury to wear a soft brace, a rigid brace or no brace. Outcomes then were measured at 12 weeks using Oswestry Disability Index (ODI) scoring, a common method for determining levels of pain and mobility in orthopaedic patients.

The mean adjusted ODI scores in the no brace and soft brace groups were 35.95 and 37.83, respectively. Similarly, the mean adjusted ODI score in the no brace and rigid brace groups were 35.95 and 33.54, respectively. In addition:

• The overall ODI Visual Analog Pain Scale (VAS) scores that measure lower back pain and anterior (front) body compression ratios (the length of the spine) did not differ significantly among the groups after 12 weeks.
• The ODI and VAS scores for back pain significantly improved with time after the fractures, and the body compression ratios significantly decreased with time in all three groups.
• There was no difference in the compression ratio, as seen on radiographic image; general health status; and patient satisfaction rates among the three groups.
• Short Form 36 (SF-36) health survey scores—which measure physical, emotional, social and mental health—decreased at 12 weeks following compression fractures in all groups, confirming previous study findings which found a decrease in life quality following a compression fracture.

“In addition to the cost and discomfort associated with braces, the findings in this study suggest that brace treatment for osteoporotic compression fractures may not provide any additional improvement in fracture healing, mobility and pain,” said Ho-Joong Kim, M.D., Ph.D., orthopedic surgeon and assistant professor at Seoul National University College of Medicine in Korea. “Moreover, the gradual deterioration in life quality, including mental and social wellbeing, associated with this condition reemphasizes the need for prevention of osteoporotic compression and other fractures.”

Study Details
Sixty patients with acute level one osteoporotic compression fractures were randomly assigned to no brace, soft brace or rigid brace groups within three days of their injury. Baseline data was collected, including sex, birth date, height, weight, smoking status and medication use. The primary outcome was the baseline adjusted Oswestry Disability Index (ODI) score at 12 weeks after compression fracture. The ODI was based on a self-administered questionnaire measuring specific spine (back) function. Secondary outcome measures included ODI score, visual analog scale score for back pain, general health status, progression of the body compression ratio over all follow-up assessments and treatment satisfaction at 12 weeks following the compression fracture. General health status was assessed using the Short Form-36 (SF-36) health survey.