Brace yourself: routine postoperative bracing after adult spinal deformity surgery offers no clinical benefit and may increase harm

Samantha Schimmel; Chloe Chose; Richard Rivera; Bryan Clampitt; Schahin Salmanian; Phillip Mitchell Johansen; Anjali Pradhan; Jay Kumar; Diego Soto Rubio; Mohsen Rostami; Alexander Haas; Erik Hayman; Mark Greenberg; Nicolas Baerga Saldana; Cesar Carballo Cuello; Puya Alikhani

doi:10.21037/jss-25-121

Brace yourself: routine postoperative bracing after adult spinal deformity surgery offers no clinical benefit and may increase harm

J Spine Surg. 2025 Dec 31;11(4):828-839. doi: 10.21037/jss-25-121. Epub 2025 Dec 19.

Authors

Samantha Schimmel¹, Chloe Chose¹, Richard Rivera¹, Bryan Clampitt¹, Schahin Salmanian², Phillip Mitchell Johansen², Anjali Pradhan², Jay Kumar², Diego Soto Rubio², Mohsen Rostami², Alexander Haas², Erik Hayman², Mark Greenberg², Nicolas Baerga Saldana³, Cesar Carballo Cuello³, Puya Alikhani²

Affiliations

¹ University of South Florida Health Morsani College of Medicine, Tampa, FL, USA.
² Department of Neurosurgery, Brain and Spine, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
³ Department of Neurosurgery, University of Puerto Rico, Medical Science Campus, San Juan, PR, USA.

Abstract

Background: Adult spinal deformity (ASD) can result in debilitating symptoms and often necessitates surgical intervention. Postoperative complications-including thromboembolic events, proximal junctional kyphosis (PJK), pseudoarthrosis, and rod fracture-are common and can severely impact outcomes. While spinal bracing is commonly employed postoperatively, its' clinical value remains unproven. The aim of this study was to compare complication rates, pain levels, and outcomes between patients who received thoracolumbosacral orthosis (TLSO) bracing and those who did not following ASD surgery.

Methods: We conducted a retrospective review of consecutive ASD surgeries at our tertiary care center between 2016 and 2023. ASD surgery was defined as multilevel fusion involving at least 5 vertebral levels, extending from the pelvis to L2 or above. Surgical approaches included open or minimally invasive methods via different interbodies such as transforaminal lumbar interbody fusion (TLIF), anterior lumbar interbody fusion (ALIF), or lateral lumbar interbody fusion (LLIF). Nine surgeons participated in the cohort.

Results: Of 265 patients, 193 (73%) received TLSO bracing postoperatively. Braced patients had a significantly increased risk of rhabdomyolysis [odds ratio (OR) =9.959; P<0.001] and deep vein thrombosis (DVT) (OR =5.960; P=0.007). Long-term opioid use (≥12 months) was more common in braced patients (OR =3.895; P=0.002), and they reported higher postoperative back and leg pain (P<0.05). Bracing was not associated with a reduction in surgical complications, nor did it improve spinopelvic alignment outcomes.

Conclusions: Routine bracing following ASD surgery does not reduce mechanical or surgical complications and may contribute to immobility-related morbidity and prolonged pain management. Forgoing postoperative bracing may improve patient outcomes and reduce healthcare costs. These findings support a reevaluation of routine bracing in ASD care.

Keywords: Adult spinal deformity surgery (ASD surgery); complications; pain; thoracolumbosacral orthosis bracing (TLSO bracing).