Continued Use of Bracing after Instrumented Lumbar Fusion: An International Study of Practice Patterns

Despite guidelines advising against routine bracing after instrumented lumbar fusion, bracing remains common in clinical practice. This study aimed to evaluate global patterns of brace utilization following 1- to 2-level lumbar fusion for degenerative pathology and to assess variation by surgeon specialty and geographic region.

An international cross-sectional survey was distributed to AO Spine members. Respondents provided information regarding their bracing practices after open and minimally invasive lumbar fusion. Responses were stratified by specialty (orthopedic vs. neurosurgery) and geographic region (Asia Pacific, Europe and South Africa, Latin America, Middle East and North Africa, North America). Statistical analysis was performed using chi-square tests, with P<0.05 considered significant.

Of 280 respondents, 253 performed 1- to 2-level lumbar fusion procedures and were included in the analysis. Bracing practices did not differ significantly based on surgeon specialty, age, gender, years in practice, fellowship training, or practice setting. However, surgeons from Asia Pacific countries reported significantly higher bracing rates following both open and MIS fusion procedures compared to other regions (P<0.001 and P=0.03, respectively). Pain control and construct protection were the most common reasons for prescribing braces.

Bracing after short-segment lumbar fusion remains prevalent worldwide, with notable regional variation. These findings highlight persistent divergence from clinical guidelines and suggest a need for greater consensus and alignment in global spine care practices.