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. 2019 Apr 11:14:671-680.
doi: 10.2147/CIA.S199853. eCollection 2019.

Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture

Eva Jacobs  1 , Rachel Senden  2 , Christopher McCrum  2   3 , Lodewijk W van Rhijn  1 , Kenneth Meijer  2 , Paul C Willems  1
Affiliations

Effect of a semirigid thoracolumbar orthosis on gait and sagittal alignment in patients with an osteoporotic vertebral compression fracture

Eva Jacobs et al. Clin Interv Aging. .

Abstract

Background: An important goal in the treatment of osteoporotic vertebral compression fractures (OVCFs) is the prevention of new vertebral fractures and the subsequent progression to global sagittal malalignment. Current conservative treatment is multimodal and comprises analgesics, medication for osteoporosis, and physical therapy. However, little is known about the value of orthoses in the treatment of OVCFs.

Aims: The primary purpose of this study was to examine the direct effect of a semirigid thoracolumbar orthosis on gait in patients suffering from an OVCF. The secondary purpose was to evaluate changes in gait, radiographic sagittal alignment, pain, and quality of life over time.

Methods: Fifteen postmenopausal patients with an OVCF were treated with a semirigid thoracolumbar orthosis. At baseline, after 6 weeks, and after 6 months, gait analysis was performed with a dual belt-instrumented treadmill with a 180° projection screen providing a virtual environment (computer-assisted rehabilitation environment) combined with clinical and radiographic assessments.

Results: At baseline, bracing caused a significantly more upright posture during walking and patients walked faster, with larger strides, longer stride times, and lower cadence compared to walking without orthosis. After 6 weeks, radiographic and dynamic sagittal alignment had improved compared to baseline. The observed effect was gone after 6 months, when the orthosis was not worn anymore.

Conclusion: A semirigid thoracolumbar orthosis seems to have a positive effect on gait and stability in patients suffering from an OVCF, as was shown by a more upright posture, which may result in decreased compressive loading of the vertebrae. For studying the true effectiveness of dynamic bracing in the treatment of OVCFs, a prospective, randomized controlled trial will be needed.

Keywords: computer assisted rehabilitation environment; dynamic bracing; gait analysis; orthosis; osteoporotic vertebral compression fracture (OVCF); sagittal alignment; trunk motion.

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Conflict of interest statement

Disclosure For the execution of or materials supplied for this study, no funding was received. CM was funded by the Kootstra Talent Fellowship awarded by the Centre for Research Innovation, Support, and Policy (CRISP) and by the NUTRIM Graduate Programme, both of Maastricht University Medical Center+. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Trunk motion over time. Higher values indicate more anterior position of the trunk in comparison to the pelvis. Notes: (A) Trunk motion at baseline. Significantly more flexed posture without orthosis (P<0.05). (B) Trunk motion after 6 weeks wearing the orthosis showed no difference between walking with and without orthosis. (C) Trunk motion after 6 months, showing a pattern comparable to that found at baseline (P<0.05).
Figure 2
Figure 2
Radiographic sagittal balance. Graphs represent mean ± SD at each time point. Notes: (A) GSA, significant improvement T0 versus T1 (P<0.001), relapse at T2. (B) GAP score, significant improvement T0 versus T1 (P=0.001), relapse at T2. (C) SVA, improvement T0 versus T1 (P=0.089), relapse at T2. (D) Wedge angle, significant increase at 6 weeks (*P<0.001) and 6 months (**P<0.001). Abbreviations: GSA, global sagittal alignment; GAP, global alignment and proportion; SVA, sagittal vertical axis.
Figure 3
Figure 3
Pain and quality of life. Graphs represent mean ± SD. Notes: (A) Statistically significant improvement in VAS score over time (T0 vs T1 P<0.001, T0 vs T2 P<0.001). (B) QUALEFFO 41 results. Statistically significant improvement over time in the QUALEFFO pain domain (T0 vs T1 P<0.001, T0 vs T2 P<0.001), physical function (T0 vs T1 P=0.001, T0 vs T2 P<0.001), and social function (T0 vs T1 P=0.091, T0 vs T2 P<0.001). Abbreviations: VAS, visual analogue scale; QUALEFFO, Quality of Life Questionnaire of the European Foundation for Osteoporosis.
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References

    1. European Prospective Osteoporosis Study. Felsenberg D, Silman AJ, et al. Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS) J Bone Miner Res. 2002;17(4):716–724. doi: 10.1359/jbmr.2002.17.4.716. - DOI - PubMed
    1. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. 2001;285(3):320–323. - PubMed
    1. Katzman WB, Wanek L, Shepherd JA, Sellmeyer DE. Age-related hyperkyphosis: its causes, consequences, and management. J Orthop Sports Phys Ther. 2010;40(6):352–360. doi: 10.2519/jospt.2010.3099. - DOI - PMC - PubMed
    1. Ailon T, Shaffrey CI, Lenke LG, Harrop JS, Smith JS. Progressive spinal kyphosis in the aging population. Neurosurgery. 2015;77(Suppl 4):S164–S172. doi: 10.1227/NEU.0000000000000944. - DOI - PubMed
    1. Broy SB. The vertebral fracture cascade: etiology and clinical implications. J Clin Densitom. 2016;19(1):29–34. doi: 10.1016/j.jocd.2015.08.007. - DOI - PubMed

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