Brace yourself: routine postoperative bracing after adult spinal deformity surgery offers no clinical benefit and may increase harm.

BACKGROUND

Adult spinal deformity (ASD) can result in debilitating symptoms and often necessitates surgical intervention. Postoperative complications-including thromboembolic events, proximal junctional kyphosis (PJK), pseudoarthrosis, and rod fracture-are common and can severely impact outcomes. While spinal bracing is commonly employed postoperatively, its' clinical value remains unproven. The aim of this study was to compare complication rates, pain levels, and outcomes between patients who received thoracolumbosacral orthosis (TLSO) bracing and those who did not following ASD surgery.

METHODS

We conducted a retrospective review of consecutive ASD surgeries at our tertiary care center between 2016 and 2023. ASD surgery was defined as multilevel fusion involving at least 5 vertebral levels, extending from the pelvis to L2 or above. Surgical approaches included open or minimally invasive methods via different interbodies such as transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), or lateral lumbar interbody fusion (LLIF). Nine surgeons participated in the cohort.

RESULTS

Of 265 patients, 193 (73%) received TLSO bracing postoperatively. Braced patients had a significantly increased risk of rhabdomyolysis [odds ratio (OR) =9.959; P<0.001] and deep vein thrombosis (DVT) (OR =5.960; P=0.007). Long-term opioid use (≥12 months) was more common in braced patients (OR =3.895; P=0.002), and they reported higher postoperative back and leg pain (P<0.05). Bracing was not associated with a reduction in surgical complications, nor did it improve spinopelvic alignment outcomes.

CONCLUSIONS

Routine bracing following ASD surgery does not reduce mechanical or surgical complications and may contribute to immobility-related morbidity and prolonged pain management. Forgoing postoperative bracing may improve patient outcomes and reduce healthcare costs. These findings support a reevaluation of routine bracing in ASD care.