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Spinova Support Plus following spondylodesis “Mobility makes patients happy“

Issue 02/2017

Do orthoses cause muscles to weaken? Dr. med. Yorck Rommelspacher from the University Hospital of Bonn (Germany) felt that it was high time to shed some light on this conundrum from a postoperative perspective and used the example of Spinova Support Plus to conduct a study1 into the matter. His research concluded that the lumbar orthosis does not impair muscle regeneration following spondylodesis, but rather helps patients regain mobility more quickly, refuting the assumption that orthoses lead to muscular atrophy.

Bauerfeind life: Where exactly did your research interest lie during the study?
Dr. Rommelspacher: As surgeons, we wanted to find out to what extent postoperative treatment with a back orthosis has an impact on the healing process, pain, and mobility. Our first question was whether orthoses are an effective follow-up treatment. And our second question was how well muscle regenerates with and without an orthosis. There is a well-known theory that orthoses interfere with muscle regeneration. Our aim was to use surface electromyography (EMG) to scientifically test this assumption so that we could either confirm or refute it.

How did you go about answering these questions?
Dr. Rommelspacher: Our study included patients who had spondylodesis affecting one or two segments of their lumbar spine. We chose a prospective, randomized study design and used surface EMG to take successive muscle activity measurements. Our investigation saw us enter unchartered territory in postoperative research, as similar EMG studies cited in the literature are largely limited to healthy patients who have not undergone surgery. This meant that we had no idea what to expect from a population of patients who had received surgery.

How did you take the EMG measurements?
Dr. Rommelspacher: We decided to use the Sørensen test to determine the isometric endurance of the lower back muscles. We asked the patients to perform a slightly modified version of this exercise with two and ten kilograms of weights. We then used EMG to detect activity in the L1 region, i.e. slightly above the site of the operation.

Spinova Support Plus stabilizes the lumbar spine with its large back pad and protects it against incorrect movements.
Spinova Support Plus stabilizes the lumbar spine with its large back pad and protects it against incorrect movements.

What were the results?
Dr. Rommelspacher: The EMG showed no significant differences between the orthosis-wearing and non-orthosis-wearing patients. This meant that the orthosis was not found to negatively affect muscle regeneration. Instead, we even saw a slight trend leaning in favor of the orthosis – although this had no statistical significance.

Apart from muscle activity, which other parameters did you investigate?
Dr. Rommelspacher: There were four others: Pain, measured using the visual analog scale (VAS); medication in accordance with the WHO regimen; degree of disability using the Oswestry Disability Index (ODI), which contains ten questions about the extent to which the patient’s everyday life is restricted by lower back pain; and finally product-specific questions on Spinova Support Plus.

What were your initial findings?

Dr. Rommelspacher: It was very clear that the patients who wore the orthosis were a lot more self-assured and felt confident enough to go out and about again. When questioned immediately after the operation, 74 percent said that the orthosis offered very good levels of protection and stabilization. Although this figure dropped slightly after six weeks, this could partly be attributed to the fact that the patients were much better again by that point and no longer required such strong stabilization. For this reason, we decided to remove the bridging pad after six weeks. After doing so, an even more significant improvement in the ODI score was recorded, equating to a considerable increase in mobility.

How did the situation develop as your investigations went on? How did the orthosis benefit the patients in their everyday lives?
Dr. Rommelspacher: From our follow-up examinations, we know that even after one year there are still a number of patients who use the orthosis for one to two hours a day – despite this no longer being necessary. For example, some wear it when they go shopping, have to carry something, or are heading out on a long walk, claiming that they like to do so for support. It gives them more confidence in themselves, which is what quality of life is all about.

From a medical point of view, how important is it to restore mobility quickly?
Dr. Rommelspacher: It is extremely important! Getting a patient out of bed more quickly has a huge impact on preventing possible complications. You only have to think of the risk of thrombosis to realize that. For me as a surgeon, I feel that my operations have been a success if my patients are able to start walking around again quickly. Mobility makes patients happy.

Which types of patient are most suited to wearing lumbar orthoses?
Dr. Rommelspacher: We discussed this question in depth. Surgery alone is often enough to restore a 55-year-old with stiffening in the lumbar region back to health. In older, less confident patients, conversely, the orthosis proves an excellent aid. It is ideal for patients who had muscle weakness before surgery and were not able to support their torso sufficiently on their own. After the operation, the orthosis gives them the help they need to get moving again more quickly.

What , in your opinion, are the benefits of Spinova Support Plus?
Dr. Rommelspacher: Without a doubt , its modular design. By that , I mean the way you can remove the back and abdominal pads and change the level of stabilization. After the orthosis has been adjusted to the wearer, the patient can put it on quickly by themselves, simply by using the two handles. It is also very lightweight for an orthosis of its kind. The worst aspect of treating patients in this field is that if they do not move, their muscles degenerate. Finding an aid that helps them get moving again is absolutely imperative. This is why it is always worth trying to treat patients with an orthosis.

1 Dr. med. Yorck Rommelspacher: Effectiveness of the Spinova Support Plus back orthosis during the postoperative treatment of segmental spondylodeses caused by degenerative conditions of the lumbar spine. Data on file.

Images: Michael Bause, Bauerfeind