Brace Yourself - Routine Postoperative Bracing After Adult Spinal Deformity Surgery Offers No Clinical Benefit and May Increase Harm

Q: What was the study’s main goal regarding postoperative bracing after ASD surgery?

To compare complication rates, pain levels, and patient outcomes between those who received TLSO bracing and those who did not after adult spinal deformity surgery.

Q: Which postoperative risks were higher in patients who received TLSO bracing?

Braced patients had increased risk of rhabdomyolysis and deep vein thrombosis, and they were more likely to use long-term opioids (≥12 months), with higher postoperative back and leg pain.

Q: Did routine bracing reduce surgical complications or improve alignment outcomes?

No. Bracing was not associated with a reduction in surgical complications and did not improve spinopelvic alignment outcomes.

Sep 30, 2026

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Routine thoracolumbosacral orthosis (TLSO) bracing after adult spinal deformity surgery is widely used, but its clinical value remains uncertain. This retrospective study compared complication rates, pain levels, and outcomes between patients who received TLSO bracing and those who did not following adult spinal deformity (ASD) surgery. Among 265 patients, bracing was linked to increased rhabdomyolysis, deep vein thrombosis, long-term opioid use, and higher postoperative back and leg pain, without improving surgical complications or spinopelvic alignment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages12

Reading Time30 min

AccessFree to download

Introduction

Background

Methods

Study design and surgical cohort

Results

Patient outcomes and complication associations

Conclusions

Brace yourself: routine postoperative bracing after adult spinal deformity surgery offers no clinical benefit and may increase harm Samantha Schimmel 1 ^, Chloe Chose 1 ^, Richard Rivera 1 ^, Bryan Clampitt 1 ^, Schahin Salmanian2 ^, Phillip Mitchell Johansen2^, Anjali Pradhan2^, Jay Kumar2^, Diego Soto Rubio2^, Mohsen Rostami2^, Alexander Haas2, Erik Hayman2^, Mark Greenberg2, Nicolas Baerga Saldana3^, Cesar Carballo Cuello3^, Puya Alikhani2 1University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; 2Department of Neurosurgery, Brain and Spine, University of South Florida Morsani College of Medicine, Tampa, FL, USA; 3Department of Neurosurgery, University of Puerto Rico, Medical Science Campus, San Juan, PR, USA Contributions: (I) Conception and design: S Schimmel, C Chose, R Rivera, J Kumar, P Alikhani; (II) Administrative support: M Rostami, A Haas, E Hayman, M Greenberg, P Alikhani; (III) Provision of study materials or patients: M Rostami, A Haas, E Hayman, M Greenberg, P Alikhani;(IV) Collection and assembly of data: S Schimmel, C Chose, R Rivera, B Clampitt, S Salmanian; (V) Data analysis and interpretation: S Schimmel, C Chose, R Rivera, B Clampitt, S Salmanian, PM Johansen, A Pradhan, J Kumar, C Carballo Cuello, D Soto Rubio, P Alikhani; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Puya Alikhani, MD, FAANS. Department of Neurosurgery, Brain and Spine, University of South Florida Morsani College of Medicine, 1 Tampa General Cir, Tampa, FL 33606, [USA. Email: palikhan@usf.edu](USA. Email: palikhan@usf.edu). Background: Adult spinal deformity (ASD) can result in debilitating symptoms and often necessitates surgical intervention. Postoperative complications—including thromboembolic events, proximal junctional kyphosis (PJK), pseudoarthrosis, and rod fracture—are common and can severely impact outcomes. While spinal bracing is commonly employed postoperatively, its’ clinical value remains unproven. The aim of this study was to compare complication rates, pain levels, and outcomes between patients who received thoracolumbosacral orthosis (TLSO) bracing and those who did not following ASD surgery. Methods: We conducted a retrospective review of consecutive ASD surgeries at our tertiary care center between 2016 and 2023. ASD surgery was defined as multilevel fusion involving at least 5 vertebral levels, extending from the pelvis to L2 or above. Surgical approaches included open or minimally invasive methods via different interbodies such as transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), or lateral lumbar interbody fusion (LLIF). Nine surgeons participated in the cohort. Results: Of 265 patients, 193 (73%) received TLSO bracing postoperatively. Braced patients had a significantly increased risk of rhabdomyolysis [odds ratio (OR) =9.959; P<0.001] and deep vein thrombosis (DVT) (OR =5.960; P=0.007) . Long-term opioid use (≥ 12 months) was more common in braced patients (OR =3.895; P=0.002), and they reported higher postoperative back and leg pain (P<0.05) . Bracing was not associated with a reduction in surgical complications, nor did it improve spinopelvic alignment outcomes. Conclusions: Routine bracing following ASD surgery does not reduce mechanical or surgical complications and may contribute to immobility-related morbidity and prolonged pain management. Forgoing postoperative bracing may improve patient outcomes and reduce healthcare costs. These findings support a reevaluation of routine bracing in ASD care. ^ ORCID: Samantha Schimmel, 0000-0001-9860-8820; Chloe Chose, 0009-0005-0159-8424; Richard Rivera, 0009-0004-0899-4916; Bryan Clampitt, 0009-0001-2152-4757; Schahin Salmanian, 0009-0007-3965-2726; Phillip Mitchell Johansen, 0000-0003-1638-2325; Anjali Pradhan, 0000-0001-6237-7522; Jay Kumar, 0000-0003-1552-5865; Diego Soto Rubio, 0000-0003-1386-9605; Mohsen Rostami,

FAQs

What was the study’s main goal regarding postoperative bracing after ASD surgery?

To compare complication rates, pain levels, and patient outcomes between those who received TLSO bracing and those who did not after adult spinal deformity surgery.

Which postoperative risks were higher in patients who received TLSO bracing?

Braced patients had increased risk of rhabdomyolysis and deep vein thrombosis, and they were more likely to use long-term opioids (≥12 months), with higher postoperative back and leg pain.

Did routine bracing reduce surgical complications or improve alignment outcomes?

No. Bracing was not associated with a reduction in surgical complications and did not improve spinopelvic alignment outcomes.

Sep 30, 2026

Uploaded by นรินทร์