Orthosis or no orthosis after surgically treated spine fractures

Rationale: There is no evidence in the current literature regarding the additional value of an orthosis after surgically treated thoracolumbar spine fractures.



Objective: To assess whether an orthosis provides additional pain relief compared to no orthosis after posteriorly fixated thoracolumbar spine fractures. Primary outcome is difference in pain at six weeks post-operatively. Secondary objectives are pain at other moments, pain medication used, pain related disability, quality of life, long-term kyphosis.



Study design: Randomized controlled intervention study, non-inferiority trial.



Study population: Dutch speaking patients presented at the VU university medical centre, 18 - 65 years old with a traumatic thoracolumbar spine fracture from Th7 – L4 surgically treated by posterior fixation.



Intervention (if applicable): One group wears an orthosis after surgery for 12 weeks, to use when in vertical position. The other group does not wear an orthosis after surgery.



Main study parameters/endpoints: Main study outcome is the difference in pain noted on the NRS-score at six weeks, ≥ 2 (SD 2,5) change corresponds with a clinically significant change in pain score.



Nature and extent of the burden and risks associated with participation, benefit and group relatedness: The current guideline for postoperative care regarding dorsal stabilization of spine fractures recommends the use of a post-operative orthosis. While patients generally receive an orthosis for 12 weeks, individual surgeon’s believes sometimes gives reason to deviate from this guideline. This is founded by literature that increasingly questions the use of orthoses in the conservative treatment of spine fractures. With the fracture operatively stabilized, the orthosis mainly provides support of gesture and thereby potentially results in pain relief and confidence for patients. On the other hand some patients report discomfort due to the device and prefer not to use it.

No orthosis is not inferior to an orthosis in terms of reported pain after dorsally fixated thoracolumbar fractures.

Day of discharge

2, 6, 12 weeks postoperative

6, 12 months postoperative

One group will receive an orthosis after surgical fixation of thoracolumbar fracture, and the other group will not use an orthosis.