The use of postoperative lumbar bracing after percutaneous vertebroplasty (PVP) for osteoporotic vertebral compression fractures (OVCFs) remains controversial, and evidence comparing brace types is limited. This study evaluated the impact of 4 postoperative bracing strategies—no-brace, soft-brace, rigid-brace, and a mixed protocol—on recovery, pain, vertebral height maintenance, and quality of life after PVP.

We conducted a prospective randomized controlled trial at a single tertiary spine center between July 2024 and March 2025. A total of 160 people with single-level OVCFs were randomized equally to No-Brace, Soft-Brace, Rigid-Brace, or Mixed-Brace (rigid brace for 4 weeks followed by soft brace for 8 weeks). Follow-up assessments were performed at 4, 8, and 12 weeks. Primary outcomes were the Oswestry Disability Index (ODI), visual analog scale (VAS) scores for back pain and stiffness, and Japanese Orthopedic Association (JOA) scores. Secondary outcomes included the physical and mental component scores of the Short Form-36 (SF-36) and anterior body compression ratio (ABCR) on radiographs to assess vertebral height preservation.

All groups showed significant improvements in function and pain over 12 weeks. At 12 weeks, the Mixed-Brace group had the lowest ODI (mean 22.5, SD 3.2), significantly lower than Rigid-Brace (mean 28.2, SD 4.5, P < 0.05) and comparable to Soft (mean 22.8, SD 4.7) and No-Brace (mean 24.2, SD 3.7). The Mixed group also achieved the highest JOA (mean 23.4, SD 1.8), best mental component score (mean 48.2, SD 5.1), and lowest stiffness VAS (mean 2.4, SD 0.7). Radiographically, Rigid and Mixed Braces preserved vertebral height better than Soft or No-Brace. No crossovers or serious adverse events occurred.

A sequential mixed-brace protocol—early rigid support followed by soft bracing—offered the best balance of stability, comfort, and psychological well-being after vertebroplasty, outperforming rigid- or soft-only bracing in short-term recovery.