Back Pain·Orthosis

Restoring mobility more quickly

Using braces after spine surgery

From Bauerfeind Life Magazin on 30.06.2022

In short Orthopedic surgeons lack knowledge about braces. This is the opinion of Prof. Dr. Robert Pflugmacher, spinal surgeon and Chief Physician at Mechernich hospital. In his experience, braces such as the Spinova Support Plus are an indispensable element of multimodal post-operative care.

  • Changing demographics have led to a significant increase in the number of spinal surgeries.
  • The most successful treatment for specific back pain – for example, as a result of scoliosis, degenerative changes, vertebral fractures, tumors or spondylolisthesis – is a combination of surgeries, orthopedic engineering and physiotherapy.
  • Working together with orthotists is a crucial factor. They know the products in detail and can instruct patients how to use the braces.
  • Braces provide relief, correct and immobilize, offering vital support during rehabilitation. They can be prescribed with no budgetary constraints.

At Mechernich Hospital in the German Eifel region, Prof. Dr. Robert Pflugmacher is establishing a maximum-care spine center. He performs surgery on patients with specific back pain due to degenerative changes, cancer, infections, scoliosis or trauma. When it comes to post-operative mobilization and pain management, braces are a fixed component of the treatment concept for him.

life: As a spine surgeon, you are the Head of the Orthopedics Department at Mechernich Hospital. Previously, you were in charge of the Spine Surgery Department at Bonn University Hospital and worked at the Charité in Berlin before that. Over the years, have you noticed any changes in that come to see you?

Prof. Dr. Robert Pflugmacher: Definitely, yes. At the beginning of my professional career, I performed a couple of spine surgeries a week. These days, it’s 20. The majority concerns degenerative cases – you can clearly observe the demographic change. And that poses new challenges, for example, in cases of osteoporotic fractures, when screws don’t hold well. You then have to use cement or 3D honeycomb implants.

For you as a surgeon, where do you see the value of braces in your treatment concept?

Prof. Dr. Robert Pflugmacher: The treatment goal is to help patients become mobile and pain-free again quickly. My concept for post-operative care includes physiotherapy and orthopedic technology. Practically all my patients are prescribed a brace. That was different over 20 years ago, when only rigid corsets were available. But these days, we have dynamic braces that help strengthen the back muscles and promote correct statics. I definitely prescribe a stabilizing brace following vertebral fracture surgery and whenever there is a degenerative component. Even in cases of minimal decompression, my patients get a small brace for two, three weeks. It reminds them that they had surgery and shouldn’t yet attempt full strain.

“My concept for post-operative care includes physiotherapy and orthopedic technology.”

Prof. Dr. Robert Pflugmacher

How do you find the perfect brace among all the possible options?

Prof. Dr. Robert Pflugmacher: I know the products, and the orthotist usually gets involved before the surgery – if the patient didn’t happen to have an acute accident. The orthotist’s assessment is important. He or she will also explain to the patient how to use the brace. The brace of my choice for stabilization is the Spinova Support Plus. I often prescribe it, for example, in cases of lumbar spine fusion or decompression across several levels. With a herniated disk in the lumbar spine, on the other hand, I often use the LumboTrain.

Are there any exceptions?

Prof. Dr. Robert Pflugmacher: Yes, obese patients, for example, or those with specific body shapes – or patients who don’t understand how to use a brace. They have to be able to safely put on and take off the brace, and it has to fit correctly on the body. But these cases are rare.

He values the stabilizing effect of a brace after surgery: spine specialist Prof. Dr. Robert Pflugmacher at Mechernich Hospital.

How long do patients have to wear the brace for, and how is physiotherapy tied in with it?

Prof. Dr. Robert Pflugmacher: In general, patients wear the brace for four to six weeks. After surgery, patients must rest for a couple of weeks, that’s important for healing. Physiotherapy can only start after that. And once physiotherapy is effective, training can work on reducing the need for the brace. There’s no point in starting physiotherapy too early. The patient will just return to me with back pain soon after. That should really only be done with minimally invasive procedures.

What evidence accompanies your work with braces?

Prof. Dr. Robert Pflugmacher: Primarily patient feedback. After surgery, patients will return to outpatient care provided by their orthopedist or neurologist, unless it’s a very complex case. The outcomes that reach me won’t be quite as systematic as those collected within a study, of course, but I know from experience that patients are mobile and happy again more quickly with this interdisciplinary treatment concept consisting of surgery, brace and training.

What do you like about treating with Bauerfeind back braces?

Prof. Dr. Robert Pflugmacher: The quality of the materials and the workmanship are crucial for me. Patient feedback is positive and, except for just a few cases, I can find the right brace for all applications in the portfolio. In special cases, custom-made solutions may be required, but the different options for stabilizing the anterior and posterior columns of the spine easily cover at least 90 percent of my patients.

Spinova Support Plus stabilizes the lumbar spine with an extensive back pad. It protects against incorrect movements and corrects the posture toward natural lordosis.

Is atrophy an issue?

Prof. Dr. Robert Pflugmacher: The myth persists, but it’s not true. This perception comes from the times when rigid plastic corsets were used. Atrophy was clearly visible after eight weeks. But that hasn’t been the case for a long time. These days, braces are much more flexible. They adapt to the patient’s body, they remain in the correct position and don’t completely restrict mobility, only to the extent that is strategically necessary.

How much do physicians’ generally know about the function and indications of braces?

Prof. Dr. Robert Pflugmacher: Orthopedic specialist who follow conservative approaches are familiar with them, but physicians who perform surgery naturally know more about screws and implants. Most surgeons don’t learn anything about the active principles of braces during their training. They don’t know either that these devices are prescribed outside the budget, i.e. they don’t impact the hospital’s budget. I had been working for several years before a colleague mentioned braces to me. Today, I can say that my treatment concept extends beyond surgery – and braces are an established part of it.

Images: Bauerfeind, Stefan Durstewitz

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