Rigid thoracolumbar orthosis devices do not provide any benefits over an elastic lumbar support in terms of bony union or health-related quality of life (HRQoL) outcomes in children with acute spondylolysis, new research has shown.
The results of a prospective study, which sought to compare clinical, radiographic and HRQoL outcomes of paediatric spondylosysis treated with a hard brace or an elastic lumbar support, were published by Ella Virkki (Turku University Hospital, Turku, Finland) et al in the Spine journal.
A total of 57 consecutive children with acute spondylolysis (mean age 14.1 years, range nine to 17 years) were prospectively enrolled. Patients were treated with a rigid thoracolumbar orthosis (Boston brace) or with a low-profile, elastic lumbar support.
The first 14 patients were randomised and the remaining 43 chose the brace type themselves. The treatment period was four months and treatment outcomes included bony union of the spondylolysis assessed with a CT scan at four months and HRQoL using the SRS-24 outcome questionnaire filled out both before and after the treatment.
Of the 57 patients, 54 completed the treatment protocol. A total of 29 patients were treated using the Boston brace and 25 patients the elastic lumbar support. Bony union was obtained in 69% (20/29) of the Boston brace and in 60% (15/25) of the elastic lumbar support group patients. Spondylolysis was graded based on its appearance in the CT and MRI and no difference in the bony union rates of these subgroups was found.
Difference in union rates was not significant (relative risk [RR] 1.14, 95% confidence interval [CI] 0.44–2.98, p=0.785). There was also no difference in the SRS-24 total or domain scores at the end of follow-up between the treatment groups (p>0.159 for all comparisons). In the whole cohort the bony union did not predict better HRQoL at the end of treatment (p=0.869), although the pain domain improved significantly in the whole cohort (p<0.001).
Speaking to Spinal News International, Virkki said: “Treatment of paediatric spondylolysis has been controversial as we know very little about the natural history of this disease. Therefore, some instances use a rigid orthosis while others do not. Based on our study the use of a rigid orthosis does not offer any benefits over an elastic lumbar support.
“This is a significant finding, as an elastic lumbar support treatment is much easier for patients and more cost-effective as well. In future it would be interesting to investigate the effectiveness of an elastic lumbar support compared to only restriction of sports without any spinal support.”