Kyphotic Angles of Instrumented Thoracolumbar Junction: Impact of Thoracolumbosacral Orthosis

Introduction: Bracing is an accepted part of operative treatment, however; the effectiveness of bracing is controversial. We sought evidences for the effect of Thoracolumbosacral Orthosis (TLSO) on spine proximal to the fusion site in patients treated for unstable thoracolumbar junction (TLJ) burst fractures. Materials and Methods: Fifty adult patients with unstable TLJ burst fractures are prospectively analyzed. All patients underwent posterior segmental instrumented spinal fusion. They were categorized into two groups randomly; the sample group (n=23) was recommended to wear a TLSO for eight weeks while the control (no brace) group was supposed not to use any orthosis. Fractured segmental kyphotic angle (FKA) and proximal kyphotic angle (PKA) were measured through standing lateral thoracolumbar x-rays by two independent observers twice after which mean value of four measurements was used. Results: Preand post-operative PKA were 6.35 ± 3.28 and 6.70 ± 3.41 (mean ± SD) degrees respectively (P=0.35) in which no statistical significant difference was observed. The mean and standard deviation of PKA among control group and TLSO group were 6.60 ± 3.43 and 6.79 ± 3.42 respectively (P=0.18), which did not show any statistical significant difference. Among all patients the differences of early postop (7.65 ± 4.59 degree) and one year post-op (9.18 ± 5.04 degree) FKA with pre-op (17.25 ± 10.34 degree) FKA is statistically significant (P < 0.001).No differences were found between male and female regarding both FKA and PKA in one-year follow up. Conclusion: Based on the results of the study we found no evidence for the effectiveness of TLSO in surgically treated patients with TLJ unstable burst fractures. Treating these patients using early ambulation without TLSO eliminates the cost and patient deconditioning associated with a brace.