Dear Colleagues:
The following are the responses I recieved.
Here are the responses to my original question on 6-2-98:
>>Dear Colleagues,
Has anyone read recent research or heard any speeches regarding the “necessity
or desirability” of Post-op spinal support given the advances in spinal
surgery? Is anyone experiencing changes in the frequency of prescriptions
for spinal supports and/or a downgrading from a L0400 type to a Corset style?
Let me know<< Pat I haven't seen the research data yet but I have noticed a significant drop in the amount and frequency of the more supportive devices, Ala the LSO-TLSO Knight and Knight Taylor types and the more used Body Jackets. The advent of the "Cage" is leading to much more stable surgery and less need for external supportive devices. The good news is that Trauma is still strong for TLSO's. Don Zielke, C.O. I haven't seen a paper reviewing any such series, however our frequency of post-op orthoses for the spine has dropped dramatically with the advancements made in segmental spinal instrumentation. -Don Katz, C.O. Texas Scottish Rite Hospital for Children Dallas, TX >
Overt the past decade, the evolution in spinal instrumentation systems
that claim to not only be segmental but also 3-column fixation has led to
some corporate slogans of “bracem from the inside” and, despite a void of
scientific support for the downgrading or elimination of post-operative
orthoses, has led to a trend to “believe” in the strength of the
procedure. Some of us (including my research colleagues) believe that Moe
was right when he took the first spinal instrumentation that was breaking
with frequency, and used a post operative cast to sucessfully prevent
hardware failure, thus “bracing the brace”. Despite some suggestions to
continue using WELL FITTED CUSTOM TLSO’s after the newer procedures, the
orthoses were abandonned. One of the instrumentation companies in 1-97
settled a class action case for hardware breakage out of court for 110
Million and despite the size of this lump sum, it only resulted in a few
thousand dollars per plaintiff (alot of breakage???) The same company
sold out to another biomedical company in 4-98 and since then, I have
seen the use of post-operative TLSO’s increase significantly. Maybe some
of the docs have figured something out, but the role of post-op TLSO’s
still needs to be investigated scientifically. THIS WOULD BE A FAIRLY
GRANDIOSE STUDY AND COST ABOUT 700K but would yield info on how much
orthosis for a given injury and procedure. Most of this was for
degenerative disorders. Docs always have believed that a TLSO is
essential after a fusion for fracture and school is not out on the TLSO
after deformity procedures. For deformity, it is thought that maybe the
TLSO is not necessary to prevent hardware failure, but it may prevent
post-op decompensation and enhance the concept of “spontaneous
correction” of the unfused lumbar segments. I believe that in the near
future the TLSO usage will continue to rise and it is UP TO US ORTHOTISTS
TO BE SURE WE USE WELL FITTED ORTHOSES NO MATTER WHAT IT TAKES AND TO
DOCUMENT AN UNREPORTED PHENOMENA OF THE REDUCTION OF POST-OP PAIN as a
mechanism of action of the orthosis.
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Thomas M. Gavin, C.O.
I think we have experienced just the opposite. I have noticed an
increase in the orders for L0400 type orthoses lately. This increase
seems to match the increased use of BAK cages and instrumentation.
John Hatch, CPO
