Bracing Versus No Bracing for the Nonoperative Management of A3/A4 Thoracolumbar Burst Fractures:

Study Design: Retrospective review of prospectively collected data. Objective: The objective of this study is to compare the clinical outcomes of patients treated with or without a stabilizing brace for neurologically intact thoracolumbar burst fractures. Summary of Background Data: The role of bracing in the nonoperative management of thoracolumbar burst fractures remains controversial. Methods: This post hoc subanalysis of a prospective, multicenter study examined patients with type A3 or A4 thoracolumbar burst fractures without neurologic deficit who were treated nonoperatively with either a stabilizing brace or no brace. The primary outcomes were achieving the minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) in the Oswestry Disability Index (ODI). Secondary outcomes included return to work, mental health, pain, and overall patient satisfaction with treatment. Results: In total, 76 patients met inclusion criteria for the study including 48 patients (63%) treated with bracing and 28 (37%) patients treated without bracing. Time-to-event analyses indicated no differences in achieving MCID or PASS in ODI between patients with and without a stabilizing brace (all P >0.05). Significantly better scores were seen in the bracing group when compared with the non-bracing group at 3 months in terms of pain and overall satisfaction with care (both P <0.05). Anxiety/depression scores were better in the bracing group at all follow-up visits except the 3-month follow-up visit when compared with the non-bracing group (all P <0.05). Conclusions: We found no statistically significant differences in PROMs, return to work, or satisfaction at 1 year between patients treated with or without bracing. However, bracing was associated with improved pain, anxiety/depression scores, and satisfaction in the early period after injury. Bracing may offer advantages in terms of patient comfort and mental health in the short term but likely has no bearing on longer-term outcome in neurologically intact patients with thoracolumbar burst fractures. Level of Evidence: Level III.