A pre-, peri- and postoperative rehabilitation pathway for lumbar fusion surgery

Abstract

Purpose: Bracing is frequently prescribed following lumbar surgery for degenerative conditions. However, previous studies failed to demonstrate advantage of postoperative lumbar bracing in both short- and long-term outcome in terms of pain, quality of life and fusion rate. The purpose of this study was to assess the prescription patterns and rationale for postoperative bracing among spinal surgeons in Belgium. Methods: A 16-item online-survey was distributed by email to spinal surgeons affiliated to the Spine Society of Belgium (N= 252). Results: A total of 105 surgeons (42%) completed the survey. The overall bracing frequency following lumbar surgery was 38%. A brace was more often prescribed following fusion procedures (52%) than after non-fusion procedures (21%) (p< 0.0001). The majority of surgeons (59%) considered bracing after at least one type of lumbar surgery. Orthopaedic surgeons (73%) reported a significantly higher rate of prescribing postoperative bracing compared to neurosurgeons (44%) (p= 0.003). Pain alleviation (67%) was the main goal for prescribing a postoperative brace. A total of 42% of the surgeons aimed to improve fusion rate by bracing after lumbar fusion procedures. A quasi-equal level of the scientific literature (29%), personal experience (35%) and teaching from peers (36%) was reported to contribute on the attitudes towards prescribing bracing. Conclusions: Postoperative bracing was prescribed by Belgian spinal surgeons following more than one third of lumbar procedures. This was underpinned by beliefs regarding pain alleviation and higher fusion rate. Interestingly, based on the scientific literature these beliefs have been demonstrated to be false.