The following is the summary of “Elastic Lumbar Support Versus Rigid Thoracolumbar Orthosis for Acute Pediatric Spondylolysis: A Prospective Controlled Study” published in the January 2023 issue of Spine by Virkki, et al.

The effects of a rigid thoracolumbar orthosis versus elastic lumbar support on the clinical, radiological, and health-related quality of life (HRQoL) outcomes of children with acute spondylolysis. This study aims to evaluate the effectiveness of a rigid brace against elastic lumbar support in treating pediatric spondylosis. Treatment of spondylolysis with a stiff orthosis has unclear benefits. Researchers prospectively enrolled 57 children diagnosed with acute spondylolysis (mean age 14.1 years, range 9-17 years). Patients were given either a low-profile elastic lumbar support or a stiff thoracolumbar orthosis (Boston brace). The first 14 patients were randomly assigned a brace type, whereas the remaining 43 made their own selection. 

There was a 4-month treatment period. HRQoL was measured using the Scoliosis Research Society-24 outcome questionnaire completed before and after therapy, and bony union of the spondylolysis was evaluated using computed tomography at 4 months. About 54 out of the 57 patients finished the entire course of treatment. The Boston brace was used to treat 29 patients, and the elastic lumbar support was used to treat 25 patients. Bony union was achieved in 60.0% (15/25) of the elastic lumbar support group and 69.0% (20/29) of the Boston brace group (Relative risk=1.14), 95% CI: 0.44-2.98, (P=0.785); no significant difference in unionization rates. At the end of the follow-up period, there was no significant difference in total or domain scores on the Scoliosis Research Society-24 between the therapy groups.

Though there was a statistically significant improvement in the pain domain for the entire sample (P<0.001), the bony union did not predict better HRQoL after treatment (P=0.869). Bony union and health-related quality of life (HRQoL) outcomes did not improve with a rigid thoracolumbar orthosis compared to elastic lumbar support in children with acute spondylolysis.