Hi. I'm Elizabeth. I'm a third year medical student at Duke. I apologize. I had concurrent talks in separate rooms, so sorry about that. Today, I'll be presenting a systematic review that we did looking at the impact of thoracolumbar bracing following spinal procedures. And our team has no financial disclosures relevant to this work. As most of you likely know, bracing of the spine externally is often implemented to limit motion, support the spinal column, and stabilize patients both in the preoperative and postoperative settings. However, the decision to brace a patient with an external orthosis often involves a very specific to the patient risk benefit analysis. No prior systematic review has been conducted on whether or not this is an efficacious practice with respect to the thoracolumbar spine. So the objective of this review is to answer two separate but important clinical questions. The first was, does postoperative bracing of the thoracolumbar spine impact clinically relevant outcomes? And the second being, does this practice impact patient-reported outcomes? So just generally, our search strategy was designed to capture spine surgery and then bracing in the postoperative setting. We excluded studies that did not specifically discuss the type of brace included. We excluded studies that did either non-operative or preoperative bracing. And we were ultimately left with six studies that we were able to include in our quantitative analysis, which left us with about 5,000 total patients to analyze. With respect to our results, our demographics in each group were fairly similar. We did end up with more braced patients, because there was a study that included only a braced cohort. Unfortunately, many of our metrics were not reported by all of the studies included, which you'll see is unfortunately a recurring theme of a lot of the data limiting our options for analysis. With respect to diagnosis, again, the groups were fairly similar for the indication for procedures, with the exception of traumatic thoracolumbar burst fractures, which were largely only included in the control cohort. In terms of patients' breakdown along pain lines, no mild, moderate, and severe pains did not show any significance when we stratified by braced and unbraced cohorts. Similarly, there was no significant difference in complication rates, either overall or by specific complication. But I will draw your attention to the fact that the overall complication rate was higher in the control group. The rate of pseudarthrosis was also higher in the control group. And conversely, the rate of wound infection was higher in the braced group. But again, none of those numbers did reach significance in the statistical analysis. With respect to our second key question of how does this impact quality of life, unfortunately, again, only three of our six studies actually included quality of life metrics. And as you can see by this fairly involved table, none of them included all of the metrics of interest. However, we were able to attain a little bit of quality of life data. None of the studies did reach significance with respect to braced versus unbraced impact on quality of life. We also looked at minimal clinically important difference to see, OK, this isn't statistically significant, but potentially does the practice of bracing create a clinical difference that isn't reaching statistical significance? Unfortunately, this data was also a little bit mixed. So most of our studies showed that the MCID was not met by bracing. There was one study where the SF12V2 was clinically significant, even though it wasn't statistically significant. But again, similar to the rest of our review, there's really mixed results within this category of quality of life impact. So in conclusion, we were not able to find any significant effect of post-operative bracing following thoracolumbar procedures on either our clinical or health-related quality of life outcomes. As you might imagine, there were significant limitations of this study. There's a paucity of available studies that actually include the metrics that we were interested in. And then many of the studies had significant heterogeneity in either the indication for procedure, the length of bracing, and things like that, which really limited our options for analysis. Our group is moving forward with both a cost-effectiveness analysis, as well as a prospective trial to try to elucidate this question, since our systematic review is not particularly enlightening. Thank you. All right. Any questions?

systematic review

thoracolumbar bracing

clinical outcomes

patient-reported outcomes

cost-effectiveness analysis