Evaluating the impact of brace use versus non-brace use on successful fusion rate in patients undergoing elective lumbar fusion surgery for degenerative diseases

Evaluating the impact of brace use versus non-brace use on successful fusion rate in patients undergoing elective lumbar fusion surgery for degenerative diseases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluating the impact of brace use versus non-brace use on successful fusion rate in patients undergoing elective lumbar fusion surgery for degenerative diseases Babak Ganjeifar, Hamid Rezaee, Vahid Bavandpour This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6846217/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 10 You are reading this latest preprint version Abstract Background: Degenerative disc disease of the lumbar spine is treated conservatively with physiotherapy, anti-inflammatory medications, and surgery for severe cases. This study aimed to investigate the effect of bracing versus non-bracing on fusion success rates in patients undergoing elective lumbar fusion surgery for degenerative diseases. This retrospective and comparative study was conducted at Shahid Kamyab and Ghaem Hospitals in Mashhad, Iran, from March 2021 to November 2024 in patients who underwent elective lumbar fusion surgery for degenerative lumbar spine disease. The case group consisted of patients who used a brace belt after surgery, whereas the control group included patients who did not use a brace belt. The fusion rate was determined using dynamic radiography and computed tomography (CT) scan data at 3, 6, and 12 months postoperatively. The Oswestry Disability Index (ODI) and general health were assessed using the Goldberg Mental Health Questionnaire (GHQ) 3 and 12 months postoperatively. Results: In this study, 400 patients were analyzed, with 200 each in the case group and 200 in the control group. The mean age of patients in the case group was 57.32 years, and in the control group, it was 56.94 years. The study found no significant differences between the case and control groups regarding gender, education, ASA class, and postoperative complications (P>0.05). Additionally, there were no significant differences in patient fusion rates at 3-, 6-, 9-, and 12-months post-surgery as well as in ODI, leg pain, back pain, and GHQ scores before surgery and at 3- and 12-months post-surgery (P>0.05). The mean return to work (RTW) time showed no significant difference between the two groups (P>0.05), and Kaplan-Meier survival analysis of RTW rates at 12 months post-intervention indicated consistent rates in both groups (P=0.602, 95% CI: 0.817-1.223). Conclusion : The study found that brace use after lumbar fusion surgery for degenerative diseases did not improve patient outcomes. There were no significant differences in disability, pain, quality of life, fusion rates, or complication rates between the patients who used a brace and those who did not. Further research is required to establish clear guidelines for postoperative care. Brace Degenerative Fusion rate Lumbar fusion surgery Figures Figure 1 Background Degenerative disc disease of the lumbar spine is characterized by gradual degeneration of the intervertebral discs in the lumbar region. The natural aging process may lead to disc degeneration, potentially resulting in complications such as back and cervical pain [ 1 ]. Management of degenerative disc disease of the lumbar spine relieves symptoms, such as back pain, reduced disc height, and impaired mobility [ 2 ]. These symptoms may progressively worsen and potentially lead to complications, such as adult scoliosis, herniated discs, spinal stenosis, and spondylolisthesis [ 3 ]. Treatment modalities for degenerative diseases of the lumbar spine include conservative approaches, such as physical therapy, anti-inflammatory medications, and strengthening exercises. In severe cases, surgical intervention is warranted [ 4 ]. Lumbar fusion surgery is now widely recognized as an effective treatment for various lumbar spinal conditions such as degenerative disc disease, spondylolisthesis, and spinal stenosis [ 5 ]. However, protocols for postoperative care and patient management following lumbar fusion surgery continue to be topics of active research and debate [ 6 ]. The success rate of elective lumbar fusion surgery for degenerative conditions can be influenced by various factors, including patient age, surgical technique, patient-specific characteristics, and existing health conditions [ 7 ]. Research has shown that over a 5-year period, patients who underwent elective 1 to 2 level lumbar fusion had a reoperation rate of 13.53% [ 8 ]. Another investigation revealed cumulative reoperation rates of approximately 4.1% at 3 months, 6.2% at 1 year, and 8.2% at 3 years [ 9 ]. Several studies have suggested that postoperative lumbar support immobilization can reduce intervertebral motion and biomechanical loading in the surgical region, potentially increasing fusion rates and reducing patient-reported pain [ 10 – 12 ]. However, the utilization of such supports necessitates careful consideration of potential drawbacks, including cutaneous irritation, impediment to rehabilitation progress, and risk of lumbar muscle atrophy due to prolonged external immobilization [ 13 ]. Despite these considerations, there is no clear consensus regarding the necessity of postoperative bracing for lumbar degenerative conditions. Consequently, spinal surgeons often base their decisions on the use of post-operative braces in clinical practice [ 14 ]. Therefore, this study aimed to evaluate the impact of brace use versus non-brace use on the successful fusion rate in patients undergoing elective lumbar fusion surgery for degenerative disease. Methods Study Population This retrospective and comparative study was conducted at the Shahid Kamyab and Ghaem Hospitals in Mashhad, Iran, from March 2021 to November 2024. The study included patients who underwent elective lumbar fusion surgery for degenerative lumbar spine disease, were over 18 years old, and had available postoperative follow-up data. Exclusion criteria included severe systemic diseases that could affect surgical outcomes and a history of previous surgery on the lumbar spine. Sampling was performed as a convenience and non-random sample based on the available information from patients in the two hospitals. Accordingly, all patients who underwent spinal surgery during the study period and one year after surgery were included in the study and were divided into two groups: case and control. The case group included patients who used a brace belt after surgery and the control group included patients who did not use a brace belt after surgery. Study protocol Study protocol All patients were first given a checklist that included age, gender, body mass index (BMI), education level, employment status, place of residence, smoking habits, ASA of Anesthesiologists class, diabetes status, postoperative complications, duration of brace use for the case group, and duration of return to work (RTW). The patient's disability level was determined using the Oswestry disability index (ODI) before the study and at 3 and 12 months postoperatively. The fusion rate was determined using dynamic radiography and CT scan data at 3, 6, and 12 months postoperatively. The level of leg and back pain for each patient was assessed using the numerical rating scale (NRS), and general health was assessed using the Goldberg Mental Health Questionnaire (GHQ) at 3 and 12 months postoperatively. The ODI is a commonly employed instrument for assessing a patient's enduring functional impairment, especially in individuals experiencing lower back discomfort. This evaluation tool comprises 10 distinct categories, each exploring various facets of everyday activities, including pain severity, self-care, weight-lifting, ambulation, sedentary posture, upright stance, rest, intimate relations (when relevant), social interactions, and transportation. Each category presents six statements rated from 0 to 5, where 0 signifies minimal disability and 5 indicates maximal disability. The final score is expressed as a percentage, ranging from 0% (no disability) to 100% (maximum disability) [ 15 ]. The GHQ is a widely used screening instrument designed to detect psychiatric disorders in community and nonpsychiatric clinical settings. The GHQ-12 comprises subscales of somatic symptoms, anxiety/insomnia, social dysfunction, and severe depression. Multiple scoring methodologies were employed, including the Likert scale (0–3). The aggregate score facilitates the determination of the presence and severity of psychological symptoms [ 16 ]. Statistical analysis Data analysis was conducted using SPSS software (version 27, Chicago, IL, USA). Mean and standard deviation were used to describe quantitative data, whereas qualitative variables were explained using frequency and percentage. The normality of variables was assessed using the Kolmogorov-Smirnov test. Statistical analyses were performed using the chi-square test. The T-test and its nonparametric equivalent, the Mann-Whitney U test, were used to compare interval variables. The significance level was set at P < 0.05. Ethical considerations The study protocol was reviewed and approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran. This study strictly adhered to all the prescribed ethical protocols. Informed consent was obtained from all the patients, and their rights were maintained throughout the study. Confidentiality was maintained by not disclosing the names of the participants and by ensuring the security of all information gathered from the research community. Results A total of 400 patients were studied, with 200 each in the case group and 200 patients in the control group. The mean ± SD age of the patients in the case group was 57.32 ± 11.26 years (range: 43 to 89 years), while the mean age in the control group was 56.94 ± 11.13 years (range: 40 to 87 years). Additionally, the mean BMI was 27.00 ± 4.03 kg/m² (range: 18.52 to 30.28 kg/m²) for the case group and 26.87 ± 4.17 kg/m² (range: 18.29 to 32.28 kg/m²) for the control group. The findings indicated that there was no significant difference between the two groups in terms of age (P = 0.744; Z=-0.326) and BMI (P = 0.683; Z =-0.409), demonstrating that they were similar. Table 1 presents the demographics and clinical characteristics of the study population by group. The findings showed that there was no significant difference between the two groups in terms of gender, education, employment status, place of residence, smoking habits, ASA class, diabetes, and postoperative complications. Consequently, the two groups were similar (P > 0.05). Table 1 The demographics and clinical history data of patient based on group Variable Case group N (%) Control group N (%) χ 2 * P-value Gender Male 91 (45.5) 85 (42.5) 0.365 0.546 Female 109 (54.5) 115 (57.5) Education Under diploma 148 (74.0) 148 (74.0) 10.310 0.136 Diploma 34 (17.0) 26 (13.0) Advanced Diploma 4 (2.0) 17 (8.5) Bachelor 10 (5.0) 7 (3.5) Master 4 (2.0) 2 (1.0) Employment status Jobless 46 (24.1) 40 (21.1) 3.881 0.567 Student 24 (12.6) 27 (14.2) Housewife 88 (46.1) 83 (43.7) Self-employed 20 (10.5) 26 (13.7) Employed 11 (5.8) 14 (7.4) Retired 2 (1.0) 0 (0.0) Place of residence Urban 121 (60.5) 127 (63.5) 0.382 0.537 Rural 79 (39.5) 73 (36.5) Smoker Yes 23 (11.5) 16 (8.0) 1.392 0.238 No 177 (88.5) 184 (92.0) ASA class I 56 (28.0) 47 (23.5) 2.580 0.240 II 108 (54.0) 104 (52.0) III 36 (18.0) 49 (24.5) Diabetes Yes 39 (19.5) 41 (20.5) 0.063 0.803 No 161 (80.5) 159 (79.5) Postoperative complications No 143 (71.5) 167 (83.5) 8.834 0.356 Dizziness 1 (0.5) 1 (0.5) Leg pain 20 (10.0) 12 (6.0) Back pain 18 (9.0) 9 (4.5) Chills 5 (2.5) 3 (1.5) visceral symptoms and constipation 1 (0.5) 1 (0.5) Spinal canal stenosis 4 (2.0) 3 (1.5) Severe infection and urinary incontinence 4 (2.0) 2 (1.0) Reoperation 4 (2.0) 2 (1.0) * chi-square test In the case group, the mean duration of brace use was 4.76 ± 4.60 months (range: 1 to 24 months). The results indicated that there were no significant differences in the patient fusion rate at 3-, 6-, 9-, and 12-months post-surgery (P > 0.05) (Table 2 ). Table 2 The fusion rate of patient based on group Fusion rate Case group N (%) Control group N (%) χ 2 * P-value After 3 months Yes 132 (66.0) 139 (69.5) 0.561 0.454 No 68 (34.0) 61 (30.5) After 6 months Yes 156 (78.0) 163 (81.5) 0.759 0.384 No 44 (22.0) 37 (18.5) After 9 months Yes 164 (82.0) 171 (85.5) 2.146 0.342 No 36 (18.0) 28 (14.5) After 12 months Yes 186 (93.0) 183 (91.5) 1.158 0.561 No 14 (7.0) 16 (8.5) * chi-square test Based on the results, there were no significant differences in the patients' ODI, leg pain, back pain, and GHQ scores before surgery and at 3- and 12-months post-surgery (P > 0.05) (Table 3 ). Table 3 Distribution of clinical test means by two study groups Variable (Mean ± SD) Case group Control group Z* P-value ODI Before the study 65.40 ± 16.50 63.25 ± 16.66 -1.419 0.156 After 3 months 24.90 ± 15.35 22.11 ± 16.22 -1.720 0.085 After 12 months 15.19 ± 9.98 14.24 ± 9.76 -1.142 0.254 Leg pain Before the study 7.12 ± 1.72 7.31 ± 1.77 -1.414 0.157 After 3 months 3.16 ± 1.72 3.39 ± 1.61 -0.963 0.336 After 12 months 1.92 ± 1.53 2.20 ± 1.84 -1.304 0.192 Back pain Before the study 7.41 ± 2.16 7.92 ± 1.65 -1.825 0.068 After 3 months 2.61 ± 1.79 2.60 ± 1.58 -0.413 0.680 After 12 months 1.47 ± 1.85 1.31 ± 2.37 -1.323 0.186 GHQ Before the study 37.88 ± 15.49 39.71 ± 15.78 -1.213 0.225 After 3 months 28.13 ± 15.39 29.93 ± 14.70 -1.240 0.215 After 12 months 21.27 ± 14.17 23.12 ± 14.25 -1.417 0.157 ODI: Oswestry disability index; GHQ: Goldberg Mental Health Questionnaire * Mann-Whitney U The overall 1-year fusion rate remained consistent between the two groups. The curve shows similar rates at 3, 6, and 12 months in both groups. In both groups, the ODI scores improved significantly 3 months after surgery but declined at the 12-month follow-up. Additionally, the leg pain, back pain, and GHQ scores of the patients improved significantly at 3 months postoperatively and were maintained at 12 months (Fig. 1 ). The patient satisfaction rates in the case and control groups were 186 (93%) and 185 (92.5%) 3 months. At 12 months, the satisfaction rate was 192 (96%) in the case group and 196 (98%) in the control group. Accordingly, the two groups were significantly different in terms of patient satisfaction rates after 3 months (P = 0.847; χ²=-0.037) and after 12 months (P = 0.241; χ²=-1.375). The mean RTW in the case group was 126.30 ± 99.77 days (range: 30–390 days) and 121.65 ± 98.01 days (range: 30–390 days) in the control group. The findings indicated no significant difference in RTW between the two groups (P = 0.588; Z = -0.542). Kaplan-Meier survival analysis of the RTW factor twelve months post-intervention showed that the RTW rate was consistent in both groups (P = 0.602, 95% CI: 0.817–1.223). Discussion The results indicated that the use of a brace in patients undergoing elective lumbar fusion surgery showed no significant differences in fusion rate, ODI score, GHQ score, leg pain, back pain, patient satisfaction rate, and RTW rate between the two groups before surgery and at 3 and 12 months after surgery. Both the groups demonstrated similar results. Specific guidelines on the use of bracing after lumbar surgery are generally lacking, highlighting a significant gap in the clinical practice. Despite the limited high-quality evidence supporting the efficacy of postoperative bracing, many spine surgeons continue to prescribe it, often based on their personal experiences, beliefs, and training, rather than robust scientific data [ 17 ]. The American Association of Neurological Surgeons (AANS) published recommendations in 2014 to address this issue. These guidelines advise against the use of bracing after instrumented posterolateral lumbar fusion, suggesting that it may not provide significant clinical benefits in such cases [ 18 ]. The basis for this recommendation stems from a single randomized controlled trial that was critically assessed and found to have low-quality evidence according to the NASS grades of recommendation. This finding raises concerns regarding the reliability and generalizability of the trial conclusions [ 19 ]. In meta-analysis, Feng et al. found that the group using a brace after lumbar fusion experienced slightly better ODI improvement in the early postoperative period, slightly greater pain relief in the late postoperative period, and a marginally lower rate of complications compared to the group that did not use a brace. However, it is important to note that these observed differences did not reach statistical significance [ 13 ]. The findings from multiple randomized controlled trials conducted by Yee et al. [ 20 ], Soliman et al. [ 21 ], Yao et al. [ 22 ], and Zoia et al. [ 23 ] have provided substantial evidence challenging the efficacy of postoperative bracing in spinal surgery. These studies consistently demonstrated that the use of braces following spinal procedures did not lead to significant improvements in key patient outcomes including disability levels, pain reduction, and overall quality of life. This lack of benefit was observed across various measures and time points during the post-operative recovery period. Furthermore, these trials revealed that postoperative bracing did not confer advantages in terms of fusion rate, which is a critical factor in the success of many spinal surgeries. The incidence of complications and need for reoperation were also comparable between patients who used braces and those who did not. These results, similar to those of our study, suggest that the routine use of postoperative bracing may not provide the anticipated benefits in spinal surgery recovery and outcomes. Consequently, these findings have important implications for clinical practice, potentially leading to a re-evaluation of postoperative bracing protocols and a more individualized approach to patient care following spinal procedures. Previous studies by Elsenbeck et al. [ 24 ] and Dimentberg et al. [ 25 ] suggested that using braces after surgery might improve fusion rates by offering stabilizing support at the operation site, thereby limiting movement between the vertebrae. However, our research did not yield results indicating a notable enhancement in fusion rates when braces were used after posterior lumbar fusion procedures. Recent studies have indicated that the benefits of bracing may be relatively modest, especially in cases of lumbar internal fixation fusion, where advancements in fixation methodologies and the role of the paraspinal musculature may play a more critical role [ 26 , 27 ]. Early biomechanical investigations have suggested that wearing a brace has a minimal impact on spinal segmental stability and the forces acting on internal fixation [ 28 ]. One possible explanation for this observation is the development of modern spinal instrumentation, which has significantly increased the rigidity and load-bearing capacity of internal fixations. This technological progress has likely contributed to improved fusion rates among patients undergoing lumbar spine surgery [ 29 ]. These findings have led to a growing debate within the medical community about the necessity and efficacy of post-operative bracing in lumbar fusion surgeries. Some surgeons argue that the potential drawbacks of bracing, such as muscle atrophy and patient discomfort, may outweigh its limited benefits, especially given the enhanced stability provided by modern fixation techniques [ 30 ]. As a result, there is an increasing trend towards early mobilization and rehabilitation protocols that focus on strengthening the core and paraspinal muscles, which may provide more substantial long-term benefits for patients undergoing lumbar fusion [ 31 ]. The success rate of lumbar spine fusion surgery can be influenced by multiple factors including the patient's health status, the specific surgical approach used, and the chosen bone graft material [ 32 ]. Typically, lumbar spine fusion demonstrates a high success rate, with fusion rates usually falling between 70% and 80% [ 33 , 34 ]. However, the current study revealed fusion rates exceeding 90% in both groups, surpassing those reported in other studies. It is crucial to recognize that outcomes may differ among individuals, with factors such as patient characteristics, surgical methods, and postoperative management significantly impacting the success of the procedure. In Iran, patients tend to be more cautious following surgery, delay their return to daily activities, and often refrain from resuming sports. This behavior could account for the higher fusion rate observed in our study than in other investigations. Additionally, our analysis did not reveal statistically significant differences in the rates of complications associated with postoperative bracing. This finding suggests that bracing does not significantly influence the occurrence of postoperative complications in patients undergoing lumbar fusion for degenerative diseases. These results are particularly noteworthy as they challenge the widely held belief that postoperative bracing contributes to improved patient outcomes by reducing complications. Furthermore, the lack of significant differences in complication rates between braced and non-braced patients underscores the need for a more nuanced understanding of factors that truly impact postoperative recovery and overall patient health. This highlights the importance of considering other elements, such as surgical techniques, patient adherence to rehabilitation protocols, and individualized patient care, when evaluating postoperative outcomes. The results of this analysis provide valuable insights for both clinicians and patients when making informed decisions regarding postoperative care strategies. As the medical community continues to explore and refine best practices for lumbar fusion surgery, it is crucial to base recommendations on robust evidence. Ultimately, the goal is to ensure that patients receive the most effective and efficient care tailored to their specific needs, thereby optimizing their chances for successful recovery. Conclusion The results of this study indicate that using a brace after lumbar fusion surgery for degenerative diseases did not provide significant benefits in improving disability, pain, or quality of life. Furthermore, there were no statistically significant differences in fusion or complication rates between patients who used a postoperative brace and those who did not. Although bracing is a common practice that is guided by surgeon preference, evidence suggests that its adoption does not have a meaningful impact on patient outcomes. These findings emphasize the need for further research and high-quality randomized controlled trials to establish clear guidelines and evidence-based practices for postoperative care in lumbar spine surgery. Abbreviations BMI Body mass index RTW Return to work ODI Oswestry disability index NRS Numerical rating scale GHQ Goldberg Mental Health Questionnaire AANS American Association of Neurological Surgeons CT Computed tomography Declarations Ethics approval and consent to participate The study protocol was reviewed and approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran. This study strictly adhered to all the prescribed ethical protocols. Informed consent was obtained from all the patients, and their rights were maintained throughout the study. Confidentiality was maintained by not disclosing the names of the participants and by ensuring the security of all information gathered from the research community. Consent for publication The authors have no conflict of interest. Availability of data and materials None Competing interests The authors have no conflict of interest Funding There is no financial for this study. Authors' contributions B. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6846217","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":470791438,"identity":"7140e92d-553e-40d8-862a-4f9594c8d975","order_by":0,"name":"Babak Ganjeifar","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Babak","middleName":"","lastName":"Ganjeifar","suffix":""},{"id":470791439,"identity":"82171c2b-d0f6-458c-a922-dba537ae0cca","order_by":1,"name":"Hamid Rezaee","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Hamid","middleName":"","lastName":"Rezaee","suffix":""},{"id":470791441,"identity":"eb9b8a19-b79c-4d21-aca6-cd7f0b41eabb","order_by":2,"name":"Vahid Bavandpour","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA30lEQVRIiWNgGAWjYDCCA0DMY8DAw8B8gPEBiM1HpBYDHga2BGYDEJuNOC0MQMVsCWwSIAGCWviONz988Kbgj4w5G/Oxyq85djJsDMwPH93Ao0XyzDFjwzlAh1m2saXdlt2WDHQYm7FxDh4tBjdy2KRBfjG432N2W3IbM1ALD5s0AS3sv8FajvGYFUtuqydKCxszTAvjx22HCWsB+UVyjoExUAtbsjTjtuM8bMwE/AIKsQ9v/sjZGxxjPvjx57Zqe3725oeP8WlBAcw8YJJY5SDA+IMU1aNgFIyCUTBiAACX7EEgfcBJWgAAAABJRU5ErkJggg==","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":true,"prefix":"","firstName":"Vahid","middleName":"","lastName":"Bavandpour","suffix":""}],"badges":[],"createdAt":"2025-06-08 08:08:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6846217/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6846217/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84919136,"identity":"c1d7f0f0-6736-4b68-898c-7b1b8e3f83d8","added_by":"auto","created_at":"2025-06-18 19:32:23","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":54776,"visible":true,"origin":"","legend":"\u003cp\u003ePropensity score–matched patient-reported outcome measures. The fusion rate (A), ODI (B), Leg pain (C), Back pain (D), GHQ (E). The curve demonstrates similar rates for all cases in both groups at 3, 6, and 12 months.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6846217/v1/7b3cfb4ce95a29071f5e6b88.png"},{"id":84921281,"identity":"bfddb605-ff92-4f1b-b5ea-d0c7da64e204","added_by":"auto","created_at":"2025-06-18 19:48:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":730623,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6846217/v1/ccba818a-f4d8-49e7-b889-d80656f124c4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating the impact of brace use versus non-brace use on successful fusion rate in patients undergoing elective lumbar fusion surgery for degenerative diseases","fulltext":[{"header":"Background","content":"\u003cp\u003eDegenerative disc disease of the lumbar spine is characterized by gradual degeneration of the intervertebral discs in the lumbar region. The natural aging process may lead to disc degeneration, potentially resulting in complications such as back and cervical pain [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Management of degenerative disc disease of the lumbar spine relieves symptoms, such as back pain, reduced disc height, and impaired mobility [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. These symptoms may progressively worsen and potentially lead to complications, such as adult scoliosis, herniated discs, spinal stenosis, and spondylolisthesis [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Treatment modalities for degenerative diseases of the lumbar spine include conservative approaches, such as physical therapy, anti-inflammatory medications, and strengthening exercises. In severe cases, surgical intervention is warranted [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLumbar fusion surgery is now widely recognized as an effective treatment for various lumbar spinal conditions such as degenerative disc disease, spondylolisthesis, and spinal stenosis [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, protocols for postoperative care and patient management following lumbar fusion surgery continue to be topics of active research and debate [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The success rate of elective lumbar fusion surgery for degenerative conditions can be influenced by various factors, including patient age, surgical technique, patient-specific characteristics, and existing health conditions [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Research has shown that over a 5-year period, patients who underwent elective 1 to 2 level lumbar fusion had a reoperation rate of 13.53% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Another investigation revealed cumulative reoperation rates of approximately 4.1% at 3 months, 6.2% at 1 year, and 8.2% at 3 years [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeveral studies have suggested that postoperative lumbar support immobilization can reduce intervertebral motion and biomechanical loading in the surgical region, potentially increasing fusion rates and reducing patient-reported pain [\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, the utilization of such supports necessitates careful consideration of potential drawbacks, including cutaneous irritation, impediment to rehabilitation progress, and risk of lumbar muscle atrophy due to prolonged external immobilization [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Despite these considerations, there is no clear consensus regarding the necessity of postoperative bracing for lumbar degenerative conditions. Consequently, spinal surgeons often base their decisions on the use of post-operative braces in clinical practice [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Therefore, this study aimed to evaluate the impact of brace use versus non-brace use on the successful fusion rate in patients undergoing elective lumbar fusion surgery for degenerative disease.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eThis retrospective and comparative study was conducted at the Shahid Kamyab and Ghaem Hospitals in Mashhad, Iran, from March 2021 to November 2024. The study included patients who underwent elective lumbar fusion surgery for degenerative lumbar spine disease, were over 18 years old, and had available postoperative follow-up data. Exclusion criteria included severe systemic diseases that could affect surgical outcomes and a history of previous surgery on the lumbar spine.\u003c/p\u003e \u003cp\u003eSampling was performed as a convenience and non-random sample based on the available information from patients in the two hospitals. Accordingly, all patients who underwent spinal surgery during the study period and one year after surgery were included in the study and were divided into two groups: case and control. The case group included patients who used a brace belt after surgery and the control group included patients who did not use a brace belt after surgery.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy protocol\u003c/h3\u003e\n\u003cdiv class=\"Heading\"\u003eStudy protocol\u003c/div\u003e \u003cp\u003eAll patients were first given a checklist that included age, gender, body mass index (BMI), education level, employment status, place of residence, smoking habits, ASA of Anesthesiologists class, diabetes status, postoperative complications, duration of brace use for the case group, and duration of return to work (RTW). The patient's disability level was determined using the Oswestry disability index (ODI) before the study and at 3 and 12 months postoperatively. The fusion rate was determined using dynamic radiography and CT scan data at 3, 6, and 12 months postoperatively. The level of leg and back pain for each patient was assessed using the numerical rating scale (NRS), and general health was assessed using the Goldberg Mental Health Questionnaire (GHQ) at 3 and 12 months postoperatively.\u003c/p\u003e \u003cp\u003eThe ODI is a commonly employed instrument for assessing a patient's enduring functional impairment, especially in individuals experiencing lower back discomfort. This evaluation tool comprises 10 distinct categories, each exploring various facets of everyday activities, including pain severity, self-care, weight-lifting, ambulation, sedentary posture, upright stance, rest, intimate relations (when relevant), social interactions, and transportation. Each category presents six statements rated from 0 to 5, where 0 signifies minimal disability and 5 indicates maximal disability. The final score is expressed as a percentage, ranging from 0% (no disability) to 100% (maximum disability) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe GHQ is a widely used screening instrument designed to detect psychiatric disorders in community and nonpsychiatric clinical settings. The GHQ-12 comprises subscales of somatic symptoms, anxiety/insomnia, social dysfunction, and severe depression. Multiple scoring methodologies were employed, including the Likert scale (0\u0026ndash;3). The aggregate score facilitates the determination of the presence and severity of psychological symptoms [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData analysis was conducted using SPSS software (version 27, Chicago, IL, USA). Mean and standard deviation were used to describe quantitative data, whereas qualitative variables were explained using frequency and percentage. The normality of variables was assessed using the Kolmogorov-Smirnov test. Statistical analyses were performed using the chi-square test. The T-test and its nonparametric equivalent, the Mann-Whitney U test, were used to compare interval variables. The significance level was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eEthical considerations\u003c/h3\u003e\n\u003cp\u003e The study protocol was reviewed and approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran. This study strictly adhered to all the prescribed ethical protocols. Informed consent was obtained from all the patients, and their rights were maintained throughout the study. Confidentiality was maintained by not disclosing the names of the participants and by ensuring the security of all information gathered from the research community.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 400 patients were studied, with 200 each in the case group and 200 patients in the control group. The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD age of the patients in the case group was 57.32\u0026thinsp;\u0026plusmn;\u0026thinsp;11.26 years (range: 43 to 89 years), while the mean age in the control group was 56.94\u0026thinsp;\u0026plusmn;\u0026thinsp;11.13 years (range: 40 to 87 years). Additionally, the mean BMI was 27.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.03 kg/m\u0026sup2; (range: 18.52 to 30.28 kg/m\u0026sup2;) for the case group and 26.87\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17 kg/m\u0026sup2; (range: 18.29 to 32.28 kg/m\u0026sup2;) for the control group. The findings indicated that there was no significant difference between the two groups in terms of age (P\u0026thinsp;=\u0026thinsp;0.744; Z=-0.326) and BMI (P\u0026thinsp;=\u0026thinsp;0.683; Z =-0.409), demonstrating that they were similar. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the demographics and clinical characteristics of the study population by group. The findings showed that there was no significant difference between the two groups in terms of gender, education, employment status, place of residence, smoking habits, ASA class, diabetes, and postoperative complications. Consequently, the two groups were similar (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe demographics and clinical history data of patient based on group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase group\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e *\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (45.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (42.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.546\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e109 (54.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e115 (57.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e 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colname=\"c3\"\u003e \u003cp\u003e88 (46.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (43.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSelf-employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (10.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (13.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (7.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRetired\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0 (0.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121 (60.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127 (63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.537\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79 (39.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (36.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSmoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.392\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177 (88.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e184 (92.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eASA class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56 (28.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47 (23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.240\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (54.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e104 (52.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIII\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e49 (24.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (19.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (20.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.803\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161 (80.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e159 (79.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003ePostoperative complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143 (71.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e167 (83.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e8.834\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"8\" rowspan=\"9\"\u003e \u003cp\u003e0.356\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDizziness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeg pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBack pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (9.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9 (4.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003evisceral symptoms and constipation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1 (0.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSpinal canal stenosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3 (1.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSevere infection and urinary incontinence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReoperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2 (1.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e* chi-square test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the case group, the mean duration of brace use was 4.76\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60 months (range: 1 to 24 months). The results indicated that there were no significant differences in the patient fusion rate at 3-, 6-, 9-, and 12-months post-surgery (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe fusion rate of patient based on group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFusion rate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase group\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAfter 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e132 (66.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e139 (69.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.454\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68 (34.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61 (30.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAfter 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156 (78.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163 (81.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (22.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37 (18.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAfter 9 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e164 (82.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171 (85.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (18.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (14.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAfter 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e186 (93.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e183 (91.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.561\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (7.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16 (8.5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e* chi-square test\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eBased on the results, there were no significant differences in the patients' ODI, leg pain, back pain, and GHQ scores before surgery and at 3- and 12-months post-surgery (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of clinical test means by two study groups\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eVariable (Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCase group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eZ*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eODI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.40\u0026thinsp;\u0026plusmn;\u0026thinsp;16.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63.25\u0026thinsp;\u0026plusmn;\u0026thinsp;16.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.156\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24.90\u0026thinsp;\u0026plusmn;\u0026thinsp;15.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e22.11\u0026thinsp;\u0026plusmn;\u0026thinsp;16.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.720\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.19\u0026thinsp;\u0026plusmn;\u0026thinsp;9.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14.24\u0026thinsp;\u0026plusmn;\u0026thinsp;9.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.254\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLeg pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.12\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.31\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.414\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.16\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.39\u0026thinsp;\u0026plusmn;\u0026thinsp;1.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.963\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.336\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.20\u0026thinsp;\u0026plusmn;\u0026thinsp;1.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.304\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBack pain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.41\u0026thinsp;\u0026plusmn;\u0026thinsp;2.16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.825\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.61\u0026thinsp;\u0026plusmn;\u0026thinsp;1.79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.60\u0026thinsp;\u0026plusmn;\u0026thinsp;1.58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.413\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.680\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.47\u0026thinsp;\u0026plusmn;\u0026thinsp;1.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;2.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.323\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGHQ\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBefore the study\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37.88\u0026thinsp;\u0026plusmn;\u0026thinsp;15.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.71\u0026thinsp;\u0026plusmn;\u0026thinsp;15.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.225\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 3 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.13\u0026thinsp;\u0026plusmn;\u0026thinsp;15.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.93\u0026thinsp;\u0026plusmn;\u0026thinsp;14.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAfter 12 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21.27\u0026thinsp;\u0026plusmn;\u0026thinsp;14.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.12\u0026thinsp;\u0026plusmn;\u0026thinsp;14.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-1.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eODI: Oswestry disability index; GHQ: Goldberg Mental Health Questionnaire\u003c/p\u003e \u003cp\u003e* Mann-Whitney U\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe overall 1-year fusion rate remained consistent between the two groups. The curve shows similar rates at 3, 6, and 12 months in both groups. In both groups, the ODI scores improved significantly 3 months after surgery but declined at the 12-month follow-up. Additionally, the leg pain, back pain, and GHQ scores of the patients improved significantly at 3 months postoperatively and were maintained at 12 months (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe patient satisfaction rates in the case and control groups were 186 (93%) and 185 (92.5%) 3 months. At 12 months, the satisfaction rate was 192 (96%) in the case group and 196 (98%) in the control group. Accordingly, the two groups were significantly different in terms of patient satisfaction rates after 3 months (P\u0026thinsp;=\u0026thinsp;0.847; χ\u0026sup2;=-0.037) and after 12 months (P\u0026thinsp;=\u0026thinsp;0.241; χ\u0026sup2;=-1.375). The mean RTW in the case group was 126.30\u0026thinsp;\u0026plusmn;\u0026thinsp;99.77 days (range: 30\u0026ndash;390 days) and 121.65\u0026thinsp;\u0026plusmn;\u0026thinsp;98.01 days (range: 30\u0026ndash;390 days) in the control group. The findings indicated no significant difference in RTW between the two groups (P\u0026thinsp;=\u0026thinsp;0.588; Z = -0.542). Kaplan-Meier survival analysis of the RTW factor twelve months post-intervention showed that the RTW rate was consistent in both groups (P\u0026thinsp;=\u0026thinsp;0.602, 95% CI: 0.817\u0026ndash;1.223).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results indicated that the use of a brace in patients undergoing elective lumbar fusion surgery showed no significant differences in fusion rate, ODI score, GHQ score, leg pain, back pain, patient satisfaction rate, and RTW rate between the two groups before surgery and at 3 and 12 months after surgery. Both the groups demonstrated similar results.\u003c/p\u003e \u003cp\u003e Specific guidelines on the use of bracing after lumbar surgery are generally lacking, highlighting a significant gap in the clinical practice. Despite the limited high-quality evidence supporting the efficacy of postoperative bracing, many spine surgeons continue to prescribe it, often based on their personal experiences, beliefs, and training, rather than robust scientific data [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The American Association of Neurological Surgeons (AANS) published recommendations in 2014 to address this issue. These guidelines advise against the use of bracing after instrumented posterolateral lumbar fusion, suggesting that it may not provide significant clinical benefits in such cases [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The basis for this recommendation stems from a single randomized controlled trial that was critically assessed and found to have low-quality evidence according to the NASS grades of recommendation. This finding raises concerns regarding the reliability and generalizability of the trial conclusions [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn meta-analysis, Feng et al. found that the group using a brace after lumbar fusion experienced slightly better ODI improvement in the early postoperative period, slightly greater pain relief in the late postoperative period, and a marginally lower rate of complications compared to the group that did not use a brace. However, it is important to note that these observed differences did not reach statistical significance [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The findings from multiple randomized controlled trials conducted by Yee et al. [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], Soliman et al. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], Yao et al. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], and Zoia et al. [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] have provided substantial evidence challenging the efficacy of postoperative bracing in spinal surgery. These studies consistently demonstrated that the use of braces following spinal procedures did not lead to significant improvements in key patient outcomes including disability levels, pain reduction, and overall quality of life. This lack of benefit was observed across various measures and time points during the post-operative recovery period. Furthermore, these trials revealed that postoperative bracing did not confer advantages in terms of fusion rate, which is a critical factor in the success of many spinal surgeries. The incidence of complications and need for reoperation were also comparable between patients who used braces and those who did not. These results, similar to those of our study, suggest that the routine use of postoperative bracing may not provide the anticipated benefits in spinal surgery recovery and outcomes. Consequently, these findings have important implications for clinical practice, potentially leading to a re-evaluation of postoperative bracing protocols and a more individualized approach to patient care following spinal procedures.\u003c/p\u003e \u003cp\u003ePrevious studies by Elsenbeck et al. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and Dimentberg et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] suggested that using braces after surgery might improve fusion rates by offering stabilizing support at the operation site, thereby limiting movement between the vertebrae. However, our research did not yield results indicating a notable enhancement in fusion rates when braces were used after posterior lumbar fusion procedures. Recent studies have indicated that the benefits of bracing may be relatively modest, especially in cases of lumbar internal fixation fusion, where advancements in fixation methodologies and the role of the paraspinal musculature may play a more critical role [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Early biomechanical investigations have suggested that wearing a brace has a minimal impact on spinal segmental stability and the forces acting on internal fixation [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. One possible explanation for this observation is the development of modern spinal instrumentation, which has significantly increased the rigidity and load-bearing capacity of internal fixations. This technological progress has likely contributed to improved fusion rates among patients undergoing lumbar spine surgery [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. These findings have led to a growing debate within the medical community about the necessity and efficacy of post-operative bracing in lumbar fusion surgeries. Some surgeons argue that the potential drawbacks of bracing, such as muscle atrophy and patient discomfort, may outweigh its limited benefits, especially given the enhanced stability provided by modern fixation techniques [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. As a result, there is an increasing trend towards early mobilization and rehabilitation protocols that focus on strengthening the core and paraspinal muscles, which may provide more substantial long-term benefits for patients undergoing lumbar fusion [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe success rate of lumbar spine fusion surgery can be influenced by multiple factors including the patient's health status, the specific surgical approach used, and the chosen bone graft material [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Typically, lumbar spine fusion demonstrates a high success rate, with fusion rates usually falling between 70% and 80% [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. However, the current study revealed fusion rates exceeding 90% in both groups, surpassing those reported in other studies. It is crucial to recognize that outcomes may differ among individuals, with factors such as patient characteristics, surgical methods, and postoperative management significantly impacting the success of the procedure. In Iran, patients tend to be more cautious following surgery, delay their return to daily activities, and often refrain from resuming sports. This behavior could account for the higher fusion rate observed in our study than in other investigations.\u003c/p\u003e \u003cp\u003eAdditionally, our analysis did not reveal statistically significant differences in the rates of complications associated with postoperative bracing. This finding suggests that bracing does not significantly influence the occurrence of postoperative complications in patients undergoing lumbar fusion for degenerative diseases. These results are particularly noteworthy as they challenge the widely held belief that postoperative bracing contributes to improved patient outcomes by reducing complications. Furthermore, the lack of significant differences in complication rates between braced and non-braced patients underscores the need for a more nuanced understanding of factors that truly impact postoperative recovery and overall patient health. This highlights the importance of considering other elements, such as surgical techniques, patient adherence to rehabilitation protocols, and individualized patient care, when evaluating postoperative outcomes.\u003c/p\u003e \u003cp\u003eThe results of this analysis provide valuable insights for both clinicians and patients when making informed decisions regarding postoperative care strategies. As the medical community continues to explore and refine best practices for lumbar fusion surgery, it is crucial to base recommendations on robust evidence. Ultimately, the goal is to ensure that patients receive the most effective and efficient care tailored to their specific needs, thereby optimizing their chances for successful recovery.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe results of this study indicate that using a brace after lumbar fusion surgery for degenerative diseases did not provide significant benefits in improving disability, pain, or quality of life. Furthermore, there were no statistically significant differences in fusion or complication rates between patients who used a postoperative brace and those who did not. Although bracing is a common practice that is guided by surgeon preference, evidence suggests that its adoption does not have a meaningful impact on patient outcomes. These findings emphasize the need for further research and high-quality randomized controlled trials to establish clear guidelines and evidence-based practices for postoperative care in lumbar spine surgery.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBMI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBody mass index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRTW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eReturn to work\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eODI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOswestry disability index\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNRS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNumerical rating scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGHQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGoldberg Mental Health Questionnaire\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eAANS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAmerican Association of Neurological Surgeons\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCT\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eComputed tomography\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Ethics Committee of Mashhad University of Medical Sciences, Mashhad, Iran. This study strictly adhered to all the prescribed ethical protocols. Informed consent was obtained from all the patients, and their rights were maintained throughout the study. Confidentiality was maintained by not disclosing the names of the participants and by ensuring the security of all information gathered from the research community.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no conflict of interest\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no financial for this study.\u003c/p\u003e\n\u003cp\u003eAuthors' contributions\u003c/p\u003e\n\u003cp\u003eB. G.: Writing – Original Draft Preparation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eV. B.: Designed object and editing article\u003c/p\u003e\n\u003cp\u003eH. R.: Data collection and analyzed data\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to thank all people who participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKawaguchi Y. Genetic background of degenerative disc disease in the lumbar spine. Spine surgery and related research. 2018;2(2):98-112.\u003c/li\u003e\n\u003cli\u003ede Oliveira CAA, Oliveira BS, Theodoro R, Wang J, Santos GS, Rodrigues BL et al. Orthobiologic Management Options for Degenerative Disc Disease. Bioengineering. 2024;11(6):591.\u003c/li\u003e\n\u003cli\u003eVan Isseldyk F, Padilla-Lichtenberger F, Guiroy A, Asghar J, Quillo-Olvera J, Quillo-Res\u0026eacute;ndiz J, Hagel V. Endoscopic treatment of lumbar degenerative disc disease: a narrative review of full-endoscopic and unilateral biportal endoscopic spine surgery. World Neurosurgery. 2024.\u003c/li\u003e\n\u003cli\u003ePenchev P, Ilyov IG, Todorov T, Petrov P-P, Traykov P. Comprehensive analysis of treatment approaches for lumbar disc herniation: a systematic review. Cureus. 2024;16(8).\u003c/li\u003e\n\u003cli\u003eFilley A, Baldwin A, Ben-Natan AR, Hansen K, Arora A, Xiao A et al. The influence of osteoporosis on mechanical complications in lumbar fusion surgery: a systematic review. North American Spine Society Journal (NASSJ). 2024:100327.\u003c/li\u003e\n\u003cli\u003eThys T, Bogaert L, Dankaerts W, Depreitere B, Van Wambeke P, Brumangne S et al. Qualitative study exploring the views of patients and healthcare providers on current rehabilitation practices after lumbar fusion surgery. BMJ open. 2024;14(5):e077786.\u003c/li\u003e\n\u003cli\u003eGreenwood J, McGregor A, Jones F, Mullane J, Hurley M. Rehabilitation following lumbar fusion surgery: a systematic review and meta-analysis. Spine. 2016;41(1):E28-E36.\u003c/li\u003e\n\u003cli\u003eWang S-K, Wang P, Li X-Y, Kong C, Niu J-Y, Lu S-B. Incidence and risk factors for early and late reoperation following lumbar fusion surgery. Journal of Orthopaedic Surgery and Research. 2022;17(1):385.\u003c/li\u003e\n\u003cli\u003eCummins D, Hindoyan K, Wu H-H, Theologis AA, Callahan M, Tay B, Berven S. Reoperation and mortality rates following elective 1 to 2 level lumbar fusion: a large state database analysis. Global spine journal. 2022;12(8):1708-14.\u003c/li\u003e\n\u003cli\u003eJones JJ, Oduwole S, Feinn R, Yue JJ. Postoperative bracing on pain, disability, complications, and fusion rate following 1\u0026ndash;3+ level lumbar fusion in degenerative conditions: a meta-analysis. Clinical spine surgery. 2021;34(2):56-62.\u003c/li\u003e\n\u003cli\u003eSakaki K, Yoshii T, Arai Y, Torigoe I, Tomori M, Onuma H et al. Effectiveness of lumbosacral orthosis after discectomy for lumbar disk herniation: a prospective comparative study. Spine. 2023;48(1):15-20.\u003c/li\u003e\n\u003cli\u003eLin G-X, Yao Z-K, Zhang X, Chen C-M, Rui G, Hu B-S. Evaluation of the outcomes of biportal endoscopic lumbar interbody fusion compared with conventional fusion operations: a systematic review and meta-analysis. World neurosurgery. 2022;160:55-66.\u003c/li\u003e\n\u003cli\u003eFeng A-P, Yu S-F, Zhu M-T, He L-R, Lin G-X. Impact of Postoperative Bracing Following Spinal Fusion for Degenerative Lumbar Conditions: An Updated Meta-Analysis of Randomized Controlled Trials. International Journal of Spine Surgery. 2024;18(5):540-50.\u003c/li\u003e\n\u003cli\u003eNoma M, Takeshita Y, Miyoshi K, Saiki F, Kawamura N, Higashikawa A et al. Postoperative Brace Prescription Practices for Elective Lumbar Spine Surgery: A Questionnaire-Based Study of Spine Surgeons in Japan. International Journal of Spine Surgery. 2025.\u003c/li\u003e\n\u003cli\u003eAghazadeh A, Sohani SM, Salehi R, Parnianpour M. Translation, Cross-Cultural Adaptation and Psychometric Properties of the Persian Version of Patient-Specific Functional Scale in Patients with Chronic Low Back Pain. Archives of Bone and Joint Surgery. 2025;13(1):47.\u003c/li\u003e\n\u003cli\u003eWojujutari AK, Idemudia ES, Ugwu LE. The evaluation of the General Health Questionnaire (GHQ-12) reliability generalization: A meta-analysis. PloS one. 2024;19(7):e0304182.\u003c/li\u003e\n\u003cli\u003eKato S, Smith JS, Driesman D, Shaffrey CI, Lenke LG, Lewis SJ, Deformity ASKF. Post-operative bracing following adult spine deformity surgery: Results from the AO Spine surveillance of post-operative management of patients with adult spine deformity. Plos one. 2024;19(4):e0297541.\u003c/li\u003e\n\u003cli\u003eDailey AT, Ghogawala Z, Choudhri TF, Watters WC, Resnick DK, Sharan A et al. Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 14: brace therapy as an adjunct to or substitute for lumbar fusion. Journal of Neurosurgery: Spine. 2014;21(1):91-101.\u003c/li\u003e\n\u003cli\u003eZan C. Interpretation of\u0026quot; Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine (2014)\u0026quot;. Chinese Journal of Contemporary Neurology \u0026amp; Neurosurgery. 2016;16(4):182.\u003c/li\u003e\n\u003cli\u003eYee A, Yoo J, Marsolais E, Carlson G, Poe-Kochert C, Bohlman H, Emery S. Use of a postoperative lumbar corset after lumbar spinal arthrodesis for degenerative conditions of the spine: a prospective randomized trial. JBJS. 2008;90(10):2062-8.\u003c/li\u003e\n\u003cli\u003eSoliman HA, Barchi S, Parent S, Maurais G, Jodoin A, Mac-Thiong J-M. Early impact of postoperative bracing on pain and quality of life after posterior instrumented fusion for lumbar degenerative conditions: a randomized trial. LWW; 2018.\u003c/li\u003e\n\u003cli\u003eYao Y-C, Lin H-H, Chang M-C. Bracing following transforaminal lumbar interbody fusion is not necessary for patients with degenerative lumbar spine disease: a prospective, randomized trial. Clinical spine surgery. 2018;31(9):E441-E5.\u003c/li\u003e\n\u003cli\u003eZoia C, Bongetta D, Alicino C, Chimenti M, Pugliese R, Gaetani P. Usefulness of corset adoption after single-level lumbar discectomy: a randomized controlled trial. Journal of Neurosurgery: Spine. 2018;28(5):481-5.\u003c/li\u003e\n\u003cli\u003eElsenbeck MJ, Wagner SC, Milby AH. Is routine bracing of benefit following posterior instrumented lumbar fusion for degenerative indications? Clinical Spine Surgery. 2018;31(9):363-5.\u003c/li\u003e\n\u003cli\u003eDimentberg R, Sinha S, Glauser G, Caplan IF, Schuster JM, McClintock SD et al. Short-term impact of bracing in multi-level posterior lumbar spinal fusion. International Journal of Spine Surgery. 2021;15(5):915-20.\u003c/li\u003e\n\u003cli\u003eLin G-X, Quillo-Olvera J, Jo H-J, Lee H-J, Covarrubias-Rosas CA, Jin C, Kim J-S. Minimally invasive transforaminal lumbar interbody fusion: a comparison study based on end plate subsidence and cystic change in individuals older and younger than 65 years. World Neurosurgery. 2017;106:174-84.\u003c/li\u003e\n\u003cli\u003eHuang C-C, Brena KR, Tabarestani TQ, Bardeesi A, Paturu M, Spears H et al. Minimally-invasive trans-facet lumbar interbody fusion using a dual-dimension expandable cage: preliminary results of a multi-institutional retrospective study. Journal of Spine Surgery. 2024;10(3):403.\u003c/li\u003e\n\u003cli\u003eHan G, Zou D, Liu Z, Zhang B, Gong C, Zhou S et al. Fat infiltration of paraspinal muscles as an independent risk for bone nonunion after posterior lumbar interbody fusion. BMC Musculoskeletal Disorders. 2022;23(1):232.\u003c/li\u003e\n\u003cli\u003eWang Z, Zhao Z, Li Z, Gao J, Li Y. Fatty infiltration in paraspinal muscles: predicting the outcome of lumbar surgery and postoperative complications. World Neurosurgery. 2024.\u003c/li\u003e\n\u003cli\u003eLiu Y, Li N-H. Factors associated with intervertebral cage subsidence in posterior lumbar fusion. Journal of Orthopaedic Surgery and Research. 2024;19(1):7.\u003c/li\u003e\n\u003cli\u003eMa T, Tu X, Li J, Geng Y, Wu J, Chen S et al. Comparative analysis of clinical efficacy of unilateral biportal endoscopic and open transforaminal lumbar interbody fusion in the treatment of lumbar degenerative. Frontiers in Surgery. 2025;12:1487168.\u003c/li\u003e\n\u003cli\u003eGoh GS, Tay AYW, Zeng GJ, Soh RCC. Long-term results of minimally invasive transforaminal lumbar interbody fusion in elderly patients: a 5-year follow-up study. Global Spine Journal. 2025;15(2):838-45.\u003c/li\u003e\n\u003cli\u003eAlhaug OK, Dolatowski FC, Thyrhaug AM, Mj\u0026oslash;nes S, Dos Reis JABPR, Austevoll I. Long-term comparison of anterior (ALIF) versus transforaminal (TLIF) lumbar interbody fusion: a propensity score-matched register-based study. European Spine Journal. 2024;33(3):1109-19.\u003c/li\u003e\n\u003cli\u003eRoh Y-H, Lee JC, Hwang J, Cho H-K, Soh J, Choi S-W, Shin B-J. Long-term clinical and radiological outcomes of minimally invasive transforaminal lumbar interbody fusion: 10-year follow-up results. Journal of Korean Medical Science. 2022;37(13).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-neurology-psychiatry-and-neurosurgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejnp","sideBox":"Learn more about [The Egyptian Journal of Neurology, Psychiatry and Neurosurgery](http://ejnpn.springeropen.com)","snPcode":"41983","submissionUrl":"https://submission.springernature.com/new-submission/41983/3","title":"The Egyptian Journal of Neurology, Psychiatry and Neurosurgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Brace, Degenerative, Fusion rate, Lumbar fusion surgery ","lastPublishedDoi":"10.21203/rs.3.rs-6846217/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6846217/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDegenerative disc disease of the lumbar spine is treated conservatively with physiotherapy, anti-inflammatory medications, and surgery for severe cases. This study aimed to investigate the effect of bracing versus non-bracing on fusion success rates in patients undergoing elective lumbar fusion surgery for degenerative diseases. This retrospective and comparative study was conducted at Shahid Kamyab and Ghaem Hospitals in Mashhad, Iran, from March 2021 to November 2024 in patients who underwent elective lumbar fusion surgery for degenerative lumbar spine disease. The case group consisted of patients who used a brace belt after surgery, whereas the control group included patients who did not use a brace belt. The fusion rate was determined using dynamic radiography and computed tomography (CT) scan data at 3, 6, and 12 months postoperatively. The Oswestry Disability Index (ODI) and general health were assessed using the Goldberg Mental Health Questionnaire (GHQ) 3 and 12 months postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e In this study, 400 patients were analyzed, with 200 each in the case group and 200 in the control group. The mean age of patients in the case group was 57.32 years, and in the control group, it was 56.94 years. The study found no significant differences between the case and control groups regarding gender, education, ASA class, and postoperative complications (P\u0026gt;0.05). Additionally, there were no significant differences in patient fusion rates at 3-, 6-, 9-, and 12-months post-surgery as well as in ODI, leg pain, back pain, and GHQ scores before surgery and at 3- and 12-months post-surgery (P\u0026gt;0.05). The mean return to work (RTW) time showed no significant difference between the two groups (P\u0026gt;0.05), and Kaplan-Meier survival analysis of RTW rates at 12 months post-intervention indicated consistent rates in both groups (P=0.602, 95% CI: 0.817-1.223).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The study found that brace use after lumbar fusion surgery for degenerative diseases did not improve patient outcomes. There were no significant differences in disability, pain, quality of life, fusion rates, or complication rates between the patients who used a brace and those who did not. Further research is required to establish clear guidelines for postoperative care.\u003c/p\u003e","manuscriptTitle":"Evaluating the impact of brace use versus non-brace use on successful fusion rate in patients undergoing elective lumbar fusion surgery for degenerative diseases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-18 19:32:18","doi":"10.21203/rs.3.rs-6846217/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-13T07:46:14+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-10T16:34:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228241874001638610769164263646569285062","date":"2026-01-09T04:09:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113212274471772218188831388811914929759","date":"2026-01-08T05:44:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-25T00:15:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"67894897561507783545427633340807760024","date":"2025-06-13T08:27:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-13T08:09:37+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-06-09T22:10:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-06-09T22:10:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Neurology, Psychiatry and Neurosurgery","date":"2025-06-08T08:00:32+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-neurology-psychiatry-and-neurosurgery","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejnp","sideBox":"Learn more about [The Egyptian Journal of Neurology, Psychiatry and Neurosurgery](http://ejnpn.springeropen.com)","snPcode":"41983","submissionUrl":"https://submission.springernature.com/new-submission/41983/3","title":"The Egyptian Journal of Neurology, Psychiatry and Neurosurgery","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"a60b76d7-5e4b-4481-add6-e6659fca6140","owner":[],"postedDate":"June 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-01-13T07:54:01+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-18 19:32:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6846217","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6846217","identity":"rs-6846217","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}