Brace Not Essential for Spinal Compression Fractures

Among patients with compression fractures, outcomes of disability, back pain, and progression of anterior body compression were similar among those treated without a brace or with soft or rigid braces, according to findings of a randomized clinical trial published in the December 3 issue of the Journal of Bone & Joint Surgery.

"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," lead author Ho-Joong Kim, MD, PhD, orthopaedic surgeon and assistant professor, Seoul National University College of Medicine, said in a news release.

"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."

Within 3 days of injury, the researchers randomly assigned 60 patients (aged 65 years and older) with acute, one-level osteoporotic compression fractures to the no-brace, soft-brace, or rigid-brace groups. The baseline adjusted Oswestry Disability Index score at 12 weeks after fracture was the main study endpoint, with a noninferiority margin set at an average of 10 points.

At 12 weeks after fracture, this main study endpoint in the no-brace group was not inferior to that in the soft-brace or rigid-brace groups.

During follow-up, the groups did not differ significantly in terms of overall Oswestry Disability Index scores, visual analog pain scale scores for back pain, anterior body compression ratios, general health status, or patient satisfaction rates.

In all three groups, the Oswestry Disability Index scores and the visual analog pain scale scores for back pain improved with time after fracture (P < .001), and the body compression ratios significantly decreased with time (P < .001). Short Form 36 health survey scores decreased at 12 weeks after compression fractures in all groups, confirming earlier evidence of reduced quality of life after a compression fracture.

The researchers point out that annual incidence of spinal compression fracture is nearly 700,000, making them nearly twice as common as other osteoporosis fractures. More than 30% of women aged 70 or more years have had one or more osteoporosis-related spinal fractures, according to the news release.

Although soft or rigid bracing is often recommended to stabilize the spine, reduce pain, and prevent further fracture site deterioration and collapse, compliance is often poor because of discomfort. Prolonged bracing may also cause muscular atrophy, deconditioning, skin irritation, higher healthcare costs, and rehabilitation delays.

The authors concluded that the disability outcomes of treatment without a brace for osteoporotic compression fractures are not inferior compared with those associated with treatment with soft or rigid braces. The progression of the anterior body compression ratio at the fractured vertebral body does not seem to be different with orthosis use compared with treatment without braces.

J Bone Joint Surg Am. 2014;96:1959-1966