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Short-term pain evolution in chronic low back pain with Modic type 1 changes treated by a lumbar rigid brace: A

Laura Boutevillain¹, Armand Bonnin¹, Aurore Chabaud¹

¹Service de médecine physique et de réadaptation, Inra Université Clermont-Auvergne, CHU Clermont-Ferrand, 63000 Clermont-Ferrand, France.

Annals of Physical and Rehabilitation Medicine

|July 28, 2018

Abstract

Background:

Blocking the lumbar or lumbosacral spine with a custom-made rigid lumbar brace, based on the mechanical origin of active discopathy, is a therapeutic option for low back pain, but no study has yet defined its applicability in low back pain.

Objective:

To assess the pain evolution of individuals with non-specific chronic low back pain associated with Modic type 1 changes treated with custom-made rigid lumbar brace.

Methods:

This was a retrospective observational study conducted in the Physical Medicine and Rehabilitation unit at Clermont-Ferrand University Hospital, France, between January 2014 and December 2016. Inclusion criteria were adults with non-specific chronic low back pain associated with Modic type 1 changes on the lumbar or lumbosacral spine confirmed by MRI. Patients had 4 consultations with the physician (baseline, 5 weeks, 3 months, and 5 months). The brace was progressively withdrawn at 3 months. The main outcome was pain improvement of at least 30% at 3 months (visual pain scale). The secondary outcome was an improvement of at least 50%. We also studied the association between pain improvement at the 2 thresholds (30 and 50%) and clinical data, level of Modic type 1 changes, and pain recurrence after withdrawal of the brace.

Results:

Among the 174 patients who wore the brace, 62 were included in the study; 49/62 (79%) showed improvement of at least 30% at 3 months. Two months after brace withdrawal, pain recurred for 30/46 patients (16 missing data). No sociodemographic, clinical or radiographic criteria were associated with pain evolution.

Conclusion:

In the present study, a rigid lumbar brace worn for 3 months was associated with a 30% reduction in pain for 79% of patients with chronic low back pain and active discopathy. However, the retrospective open and uncontrolled design of our study limits our interpretation about a specific treatment effect. A prospective randomized controlled trial is needed to clarify the effect of a rigid lumbar brace in this condition.

Keywords:

Active discopathy Modic type 1 changes Non-specific chronic low back pain Rigid lumbar brace

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