Department of Neuroscience, Neurosurgery Unit, Azienda Ospedaliero-Universitaria di Modena, Università degli Studi di Modena e Reggio Emilia, Via Pietro Giardini, 1355, 41126, Modena, Baggiovara, Italy.
Department of Neurosurgery, Ospedali Riuniti di Ancona, Università Politecnica delle Marche, Ancona, Italy.
Eur Spine J. 2020 Feb;29(2):321-331. doi: 10.1007/s00586-019-06202-y. Epub 2019 Nov 1.
Postoperative bracing treatment is widely used after surgery for lumbar degenerative diseases. However, the guidelines are lacking in this regard, and its use is mainly driven by individual surgeon preferences. The objective of the current review was to evaluate the available evidence on the use of postoperative bracing after surgery for degenerative disease of the lumbar spine.
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed while conducting a systematic search of the PubMed/Medline, Scopus, and Cochrane databases from January 1990 to January 2019. High-quality studies were included that evaluated disability, pain, quality of life, the rate of fusion, complications, and rate of reoperations in patients who had surgery for lumbar degenerative disease, with and without postoperative bracing. The overall strength of evidence across the studies was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework.
Of the 391 citations screened, four randomized controlled trials met the inclusion criteria and were included in the review. Based on low- to moderate-quality evidence, postoperative bracing in patients with lumbar degenerative disease does not result in improved disability, pain, and quality of life compared to no bracing patients. Low-quality evidence suggests that there was no significant difference between the two groups in terms of the rate of fusion, complications, and the need for reoperation.
To date, there is not a medical evidence to support the use of bracing after surgery for lumbar degenerative disease. These slides can be retrieved under Electronic Supplementary Material.
术后支具治疗在腰椎退行性疾病手术后广泛应用。然而，目前缺乏相关指南，其使用主要取决于个别外科医生的偏好。本综述的目的是评估现有关于腰椎退行性疾病手术后使用术后支具的证据。
遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南，对 1990 年 1 月至 2019 年 1 月期间 PubMed/Medline、Scopus 和 Cochrane 数据库进行了系统搜索。纳入评估腰椎退行性疾病手术患者（有无术后支具）的残疾、疼痛、生活质量、融合率、并发症和再手术率的高质量研究。使用推荐评估、制定和评估（GRADE）框架评估研究间证据的总体强度。
在筛选的 391 条引用中，有 4 项随机对照试验符合纳入标准并纳入了综述。基于低到中等质量证据，与不使用支具的患者相比，腰椎退行性疾病患者术后使用支具并不能改善残疾、疼痛和生活质量。低质量证据表明，两组在融合率、并发症和再次手术的需求方面没有显著差异。
迄今为止，没有医学证据支持腰椎退行性疾病手术后使用支具。这些幻灯片可以在电子补充材料中检索到。
