The grades of recommendations (standards, guidelines, and options) and classes of evidence (I–III) are defined at the end of the "Major Recommendations" field.
Standards. There is insufficient evidence to recommend a treatment standard.
Guidelines. The short-term use of a rigid lumbar support (1 to 3 weeks) is recommended as a treatment for low-back pain of relatively short duration (<6 months). The use of a lumbar brace for patients with chronic low-back pain is not recommended because there is no pertinent medical evidence of any long-term benefit or evidence that brace therapy is effective in the treatment of patients with chronic (> 6 months) low-back pain.
Options. 1) Lumbar braces are recommended as a means of decreasing the number of sick days lost due to low-back pain among workers with a previous lumbar injury. They are not recommended as a means of decreasing low-back pain in the general working population. 2)The use of lumbar brace therapy as a preoperative diagnostic tool to predict outcome following lumbar fusion surgery is not recommended. 3) The use of transpedicular external fixation as a tool to predict outcome following lumbar fusion surgery is not recommended.
Summary
Although conflicting reports have been presented in the literature regarding the utility of lumbar braces for the prevention of low-back pain, most Class III medical evidence suggests that these supports used prophylactically do not reduce the incidence of low-back pain or decrease the amount of time lost from work in the general working population. Among workers with a history of a back injury, their use appears to decrease the number of work days lost due to back pain. Lumbar braces appear to be an effective treatment for acute low-back pain in some populations. They do not appear to be effective in the chronic low-back pain population. If a brace is used, rigid braces offer some benefit over soft braces.
There are no data to suggest that relief of low-back pain with preoperative external bracing predicts a favorable outcome following lumbar spinal fusion. No information is available on the benefit of bracing for improving fusion rates or clinical outcomes following instrumented lumbar fusion for degenerative disease.
Definitions:
Grades of Recommendation
Standards Recommendations of the strongest type, based on Class I evidence reflecting a high degree of clinical certainty
Guidelines Recommendations based on Class II evidence reflecting a moderate degree of clinical certainty
Options Recommendations based on Class III evidence reflecting unclear clinical certainty
Classes of Evidence
Class I Evidence from one or more well-designed, randomized controlled clinical trials, including overviews of such trials
Class II Evidence from one or more well-designed comparative clinical studies, such as nonrandomized cohort studies, case-control studies, and other comparable studies, including less well-designed randomized controlled trials
Class III Evidence from case series, comparative studies with historical controls, case reports, and expert opinion as well as significantly flawed randomized controlled trials