Authors: Elizabeth Howell; Mostafa Gabr, MD; Daniel Villalobos; Timothy Wang, MD; Elisabeth Tuoko, NP; Brice Painter, PA; Alexia Bwensa; Muhammad Abd-El-Barr, MD, PhD; Isaac Karikari, MD; C. Rory Goodwin, MD, PhD (Durham, NC)

Introduction: Thoracolumbar fusion is indicated in a variety of spinal pathologies, including trauma, tumor, degenerative disk disease, and scoliosis. However, significant variability exists in the implementation of postoperative orthoses following these procedures. The potential stability conferred by immobilization must be balanced by the potential morbidity and associated discomfort. Limited clinical evidence is available to codify the risks and benefits of bracing following thoracolumbar fusion. Via a systematic review of the literature, this study aims to assess the utility of external fixation of the thoracolumbar spine following fusion procedures. Methods: A systematic review was performed using Medline. Our search included studies that evaluated the impact of post-operative bracing on complications or quality-of-life following spinal fusion, and was limited to literature published between 1990 and 2018. Results: Our search identified a total of 1706 publications. Of these, 29 publications evaluated bracing in the post-operative setting. These were subsequently narrowed to only five studies that specifically analyzed postoperative bracing in thoracolumbar patients following spinal fusion. Data extracted from each of the five papers included demographic information, surgical details, complication rates, and a variety of quality of life measures. Mean complication rates, instrumentation failure rates, pseudarthrosis rates, Owestry Disability indices, visual analog scale Spine Scores, SF-12v2 scores, American Spinal Injury Association impairment scores, and Roland Morris Disability scores, were calculated across bracing and control cohorts and compared using independent samples t-test. Ultimately, thoracolumbar bracing was not found to significantly affect complication rates, or impact postoperative quality of life. Conclusion: This study does not find any significant effect of postoperative bracing on complication rates or quality-of-life for patients recovering from thoracolumbar fusion. This systematic review was limited by a dearth of available literature, and indicates a need for further exploration of this topic to determine optimal postoperative management of such patients.