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Cervical Collars Not Necessarily Helpful After Single-Level Anterior Cervical Fusion with Plate
When someone has problems with the discs in their neck, the cervical discs, surgery is often needed. In the 1950s, two surgeons (Bailey and Badgley) developed a procedure that allowed surgery to fuse the discs together be done through the front (anterior) rather than the back (posterior). There were some problems with this though, as the patients often were limited in their range of motion and how well the fusion worked. Three other surgeons (Cloward, Smith, and Robinson) worked on improving the technique by immobilizing the patients after surgery and using devices to limit the patients' ability to move the neck as it healed.
Even later on, two other surgeons (Bohler and Gaudernak) began using plates in their surgery to stabilize the neck if there were fracture dislocations. These have been adapted over the years to cause more improvements. Such plates in the cervical spine tended to support the neck for healing and this reduced how often the grafts failed. However, collars to support the neck and limit neck movement have still been used after surgery and the authors of this article evaluated if using the collar improved the surgery outcome.
The researchers analyzed the outcomes of 257 patients who had single-level anterior cervical fusion with plate; 149 had braces after surgery, 108 didn't. The patients were evaluated before surgery and then again at one and a half months, three months, and six months after surgery and then again at one year and 2 years after. The researchers looked at reported neck and arm pain, neck disability, and neurologic exams. X-rays were also done to check how well the neck had fused.
Results showed that there was no statistical differences between the two groups after surgery, at any point. The only difference was with the SF-36 questionnaire part that asks about quality-of-life, where the non-braced patients scored higher. The average pain scales improved for both groups from 68.6 out of 100 for the braced group and 70.4 for the non-braced group before the surgery to 15.3 out of 100 and 17.3, respectively, 2 years after the surgery.
The authors concluded that using a brace after this type of surgery does not improve fusion rates or the pain and disability levels after surgery. Neither being braced or not being braced had any effect on hardware or graft failures. The authors do point out some limitations to the study, however. The patients weren't randomized to the groups, so this may have played a role in the success. As well, the fact that the study was on only one level of surgery means that these findings can't be carried over to multi-level surgeries.
Mitchell J. Campbell, MD, et al. Use of Cervical Collar After Single-Level Anterior Cervical Fusion With Plate. In Spine. January 2009. Vol. 34. Pp. 43 to 48.
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