Rehab: Activating orthosis for a strong back after vertebral fracture

Active upright spinal orthoses can improve back pain and kyphosis levels in acute vertebral fractures. It was unclear whether they were also effective in older fractures.

Recommendation for acute fractures

Vertebral fractures are a common consequence of osteoporosis. They can result in chronic back pain, functional limitations as well as psychological and social impairments and considerably reduce the quality of life. In addition to medication and physiotherapy, conservative treatment methods include spinal orthoses, which strengthen the back muscles and improve functionality. The German Osteological Association (or Dachverband Osteologie e.V. - DVO) recommends these in its S3 guidelines for acute, stable osteoporotic vertebral fractures.

How the back orthosis works

16 weeks of consistent wear 

In their randomised controlled trial (Effects of the “Spinomed active” orthosis on chronic back pain in kyphotic women with osteoporotic vertebral fractures three months and older; doi: 10.3389/fpain.2022.1038269), Matthias Hettchen and his team included women aged 65 and over for the first time, in whom the fracture had already occurred some time ago (≥ 3 months) and who suffered from chronic back pain. The 80 female subjects were randomised into two groups. One half (n = 40) was fitted with Spinomed® active, which was individually adapted in each case.

The participants wore the back orthosis for several hours a day for 16 weeks. Every fortnight, telephone interviews were conducted on the handling of the orthosis and on complaints while wearing it. In case of problems, the women received help from an orthopaedic technician.

Less pain and a straighter back

For the primary endpoint (back pain), the subjects with orthoses performed significantly better than the control group. On a scale of 1-10, the pain improved by an average of 1.49 points, which is significant. At the same time, the intervention group took less pain medication.

The group with orthosis was also ahead in the secondary endpoints kyphosis angle, trunk strength, functionality and disability. However, there was no improvement in respiratory function, measured by the forced vital capacity FVC. The positive effect that was determined in earlier studies through the straightening of the trunk could not be confirmed here.

High adherance

There were few problems in using the Spinomed® active, and compliance was over 80%. Some women reported muscle soreness at the beginning, but this subsided after two weeks. Others had shoulder problems before and therefore had difficulties putting on and taking off the orthosis. Two women reported mild skin irritation.

Overall, the researchers from Matthias Hettchen's team certified that the activating back orthosis is highly effective for osteoporotic vertebral fracture and chronic back pain, regardless of the age of the fracture, and advocate an extension of the recommendation.

Conclusion for medical practice

Activating back orthoses strengthen the back muscles and thus straighten the entire trunk. This in turn improves balance and stability, which reduces the tendency to fall. Thus, the active straightening orthoses also offer effective prophylaxis against secondary fractures. Older women in particular, who have difficulty with conventional back training, can benefit from this.