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Objective <p>To evaluate the necessity and technique-specific impact of postoperative bracing on clinical outcomes and multifidus muscle functional cross-sectional area (fCSA) following three distinct lumbar endoscopic discectomies.</p> Methods <p>A retrospective cohort study was conducted on 457 patients with lumbar disc herniation who underwent unilateral biportal endoscopy (UBE, <i>n</i> = 157), interlaminar endoscopic lumbar discectomy (IELD, <i>n</i> = 170), or transforaminal endoscopic lumbar discectomy (TELD, <i>n</i> = 130). Within each surgical cohort, patients were divided into brace and non-brace groups. A strict 1:1 propensity score matching (PSM) was performed to balance baseline demographics and preoperative characteristics. Clinical outcomes, including the Visual Analog Scale (VAS) for back pain, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores, alongside MRI-based multifidus fCSA, were assessed up to 6 months postoperatively.</p> Results <p>Following PSM, all baseline variables were excellently balanced across the subgroups. In the UBE cohort, patients without postoperative bracing experienced significantly worse early back pain (VAS) and functional deterioration (ODI, JOA) at the 1-month follow-up compared to the braced group. Notably, strict bracing across all surgical cohorts inherently resulted in significant multifidus atrophy at 6 months, whereas early brace weaning allowed for fCSA recovery (<i>p</i> &lt; 0.05). Therefore, for UBE, early brace weaning preserved muscle fCSA but at the severe cost of early clinical deterioration. Conversely, in both the IELD and TELD cohorts, early brace weaning safely prevented bracing-induced atrophy without compromising early clinical recovery compared to strictly braced patients.</p> Conclusion <p>The requirement for postoperative bracing after lumbar endoscopic surgery is highly technique dependent. UBE necessitates postoperative bracing to mitigate severe early structural pain, representing a necessary biomechanical compromise despite the inherent risk of bracing-induced multifidus atrophy. Conversely, the minimal structural disruption in IELD and TELD allows for safe and immediate brace weaning, which not only prevents disuse atrophy but also perfectly aligns with the principles of Enhanced Recovery After Surgery (ERAS).</p>

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Tailored postoperative bracing strategies following three distinct lumbar endoscopic discectomy: a propensity score-matched analysis

  • 期刊论文

  • 发表日期：

    2026年8月4日

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  • Xiaojun Yu,
  • Kaiyuan Lin,
  • Shanxi Wang,
  • Jianbin Guan

摘要

Objective

To evaluate the necessity and technique-specific impact of postoperative bracing on clinical outcomes and multifidus muscle functional cross-sectional area (fCSA) following three distinct lumbar endoscopic discectomies.

Methods

A retrospective cohort study was conducted on 457 patients with lumbar disc herniation who underwent unilateral biportal endoscopy (UBE, n = 157), interlaminar endoscopic lumbar discectomy (IELD, n = 170), or transforaminal endoscopic lumbar discectomy (TELD, n = 130). Within each surgical cohort, patients were divided into brace and non-brace groups. A strict 1:1 propensity score matching (PSM) was performed to balance baseline demographics and preoperative characteristics. Clinical outcomes, including the Visual Analog Scale (VAS) for back pain, Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores, alongside MRI-based multifidus fCSA, were assessed up to 6 months postoperatively.

Results

Following PSM, all baseline variables were excellently balanced across the subgroups. In the UBE cohort, patients without postoperative bracing experienced significantly worse early back pain (VAS) and functional deterioration (ODI, JOA) at the 1-month follow-up compared to the braced group. Notably, strict bracing across all surgical cohorts inherently resulted in significant multifidus atrophy at 6 months, whereas early brace weaning allowed for fCSA recovery (p < 0.05). Therefore, for UBE, early brace weaning preserved muscle fCSA but at the severe cost of early clinical deterioration. Conversely, in both the IELD and TELD cohorts, early brace weaning safely prevented bracing-induced atrophy without compromising early clinical recovery compared to strictly braced patients.

Conclusion

The requirement for postoperative bracing after lumbar endoscopic surgery is highly technique dependent. UBE necessitates postoperative bracing to mitigate severe early structural pain, representing a necessary biomechanical compromise despite the inherent risk of bracing-induced multifidus atrophy. Conversely, the minimal structural disruption in IELD and TELD allows for safe and immediate brace weaning, which not only prevents disuse atrophy but also perfectly aligns with the principles of Enhanced Recovery After Surgery (ERAS).