Noma Michita, Takeshita Yujiro, Miyoshi Kota, Saiki Fumiko, Kawamura Naohiro, Higashikawa Akiro, Hara Nobuhiro, Ono Takashi, Kato So, Matsubayashi Yoshitaka, Taniguchi Yuki, Tanaka Sakae, Oshima Yasushi
Department of Orthopedic and Spine Surgery, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
University of Tokyo Spine Group (UTSG), Tokyo, Japan.
Int J Spine Surg. 2025 May 12;19(2):237-245. doi: 10.14444/8719.
The efficacy of postoperative braces for degenerative lumbar disorders has long been debated, with conflicting reports regarding the promotion of bone fusion and pain relief. The current aspects of postoperative brace prescriptions have been previously reported in Western countries but not in Asia. This study aimed to elucidate prescription practices in Japan and identify factors influencing prescription decisions.
The survey was conducted at a spine group research meeting comprising spine surgeons from multiple institutions. The questionnaire assessed aspects of postoperative brace prescription, including the type, purpose, and duration of usage, categorized by surgical procedures for degenerative lumbar disorders: endoscopic decompression, open surgery decompression, and fusion involving 1 or more than 3 levels. The respondents' backgrounds, scientific knowledge of postoperative braces, nonscientific reasons, and basis for prescription decisions were also investigated.
There were 63 valid responses. The overall postoperative brace prescription rate was 83%, with 66% for decompression and 98% for fusion procedures, surpassing the rates reported in Western studies. The primary prescription purpose was to slow down patient activity (83%, double the previously reported rates). Prescription rates for endoscopic and open surgical decompression were significantly correlated with facility attributes and annual number of surgeries. Scientific knowledge of postoperative braces was lacking in 56% of respondents, with scientific evidence being the least frequent decision for brace prescription (14%). Nonscientific reasons influenced the prescription decisions of 84% of participants.
The postoperative brace prescription rate among spine surgeons in Japan was significantly higher than that in Western studies, largely due to nonscientific factors such as physician reassurance and the intention to slow down patient activity. Comprehensive, evidence-based guidelines are needed regarding consistent brace usage to optimize patient outcomes.
This study highlights the high postoperative brace prescription rates among spine surgeons in Japan, which are significantly influenced by nonscientific factors, such as tradition, physician reassurance, and patient satisfaction, rather than scientific evidence. These findings underscore the need for evidence-based guidelines to improve consistency in postoperative brace usage. The results are particularly relevant in regions with aging populations and a high prevalence of osteoporosis, providing insights for improving postoperative management strategies and patient outcomes in Japan as well as in similar demographic settings globally.
术后支具对退行性腰椎疾病的疗效长期以来一直存在争议，关于促进骨融合和缓解疼痛的报道相互矛盾。西方国家此前已报道过术后支具处方的现状，但亚洲尚未有相关报道。本研究旨在阐明日本的处方做法，并确定影响处方决策的因素。
该调查在一个由多家机构的脊柱外科医生组成的脊柱研究小组会议上进行。问卷评估了术后支具处方的各个方面，包括类型、目的和使用时长，按退行性腰椎疾病的手术方式分类：内镜减压、开放手术减压以及涉及1个或超过3个节段的融合手术。还调查了受访者的背景、对术后支具科学知识的了解、非科学原因以及处方决策的依据。
共收到63份有效回复。术后支具总体处方率为83%，减压手术为66%，融合手术为98%，超过了西方研究报道的比率。主要处方目的是减缓患者活动（83%，是此前报道比率的两倍）。内镜和开放手术减压的处方率与机构属性和年手术量显著相关。56%的受访者缺乏术后支具的科学知识，科学证据是支具处方最不常见的决策依据（14%）。84%的参与者的处方决策受非科学因素影响。
日本脊柱外科医生的术后支具处方率显著高于西方研究，这主要归因于非科学因素，如医生的安心考量以及减缓患者活动的意图。需要制定全面的、基于证据的指南，以规范支具的使用，优化患者预后。
本研究凸显了日本脊柱外科医生术后支具高处方率，这受到传统、医生安心考量和患者满意度等非科学因素的显著影响，而非科学证据。这些发现强调了基于证据的指南对于提高术后支具使用一致性的必要性。这些结果在老龄化人口和骨质疏松症高发地区尤为相关，为改善日本以及全球类似人口结构地区的术后管理策略和患者预后提供了见解。
