CONTROVERSY - BRACING OF PATIENTS AFTER FUSION FOR DEGENERATIVE PROBLEMS OF THE LUMBAR SPINE - YES OR NO

The majority of spine fusions currently performed are for degenerative conditions. Controversy exists regarding whether to routinely brace p atients during the postoperative period. The benefits of a rigid ortho sis have yet to be documented in a scientific study, and the cost of a custom-molded orthosis can be quite high. An extensive literature sea rch reveals few articles dealing with the subject, and none with an ad equate study design to convincingly support or refute the use of exter nal braces. In addition to the questions of whether an external brace is effective, the mechanism of action also remains unclear. It has bee n difficult to document mechanical effectiveness, so perhaps the effec t is psychologic. In addition, it is possible that some, not all, fusi on patients may benefit from a brace-yet our ability to select such a patient is poor. As a result, we have solicited the views of two exper ienced surgeons on the topic. Dr. Connolly argues that an external ort hosis is advisable in many cases; Dr. Grob feels that the rigidity of internal fixation should be adequate to obviate the need for external bracing.