Utility of Cervical Collars Following Cervical Fusion Surgery. Does It Improve Fusion Rates or Outcomes? A Systematic Review

Karikari, Isaac O.; Ghogawala, Zoher; Ropper, Alexander E.; Yavin, Daniel; Gabr, Mostafa; Goodwin, C. Rory; Abd-El-Barr, Muhammad M.; Veeravagu, Anand; Wang, Marjorie C.

doi:10.1016/j.wneu.2018.12.066

Cited by 9 publications

(11 citation statements)

References 19 publications

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“…[5] Karikari et al performed a systemic review and concluded that there is no strong evidence supporting routine use of postoperative collar after 1-and 2-segment ACDF. [4] These are consistent with the conclusion in this study that the length of time period of wearing collar has no signi cant effect on the JOA score at 3 months after surgery. Abbott et al conducted a randomized controlled pilot trial which showed that wearing a neck brace for 6 weeks after surgery can signi cantly reduce NDI and the level of neck pain.…”

Section: Discussionsupporting

confidence: 92%

“…There are different opinions in the literature on the time period of wearing collar after ACDF. Several studies have shown that 1-2 segment ACDF does not require postoperative external cervical support, [4][5][6] and other literature reported that patients who underwent 1-2 segment ACDF needed wearing collar for 4-12 weeks with off-bed ambulation [7][8][9][10][11]. Therefore, it is very important to study the impact of different time period of wearing cervical collar after ACDF on the safety, comfort and prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

“…(1)(2)(3)(4) week,[5][6][7][8] week, and 9-12 week) of wearing protective collar after ACDF. Comparison of JOA scores across the three groups shows that different time period has no statistically signi cant difference as per the rehabilitation of nerve function.…”

mentioning

confidence: 99%

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Optimal Time Period of Wearing Protective Collar After Anterior Cervical Discectomy and Fusion

Qian

Liu

et al. 2020

Preprint

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Background: There is still no consensus on the time period of wearing collar after anterior cervical discectomy and fusion (ACDF). We aim to investigate the optimal time period of wearing protective collar.Methods: We retrospectively reviewed patients with cervical spondylosis who underwent one to two segment ACDF during January 2016 and December 2017, and included 97 patients who meet inclusion and exclusion criterion. Patients were divided into three groups according to the actual time period of wearing collar after ACDF including 1-4 week group, 5-8 week group, and 9-12 week group. We analyzed Japanese Orthopedic Association (JOA) score, Axial Symptom (AS) score and Neck Disability Index (NDI) before surgery and at post-operative 3 months to investigate the optimal time period of wearing collar.Results: JOA score: All three groups have a better post-operative JOA score compared with that before surgery (paired t test, p<0.05). There is no significant difference among the three groups with respect to post-operative JOA (ANOVA, p>0.05).AS score: The post-operative AS scores of 1-4 week group and 5-8 week group were significantly better than that before surgery (paired t test, p>0.05). While the post-operative AS score of 9-12 week group was significantly worse than preoperative AS score (paired t test, p<0.05).NDI: All three groups have a better post-operative NDI compared with that before surgery (McNemar test, p<0.05). Of note, in 5-8 week group, the percentage of no deficit increased by 45%, and the percentage of mild deficit decreased by 45% accordingly. That percentage is 26% and 31% in 1-4 week group and 9-12 week group, respectively. There was significant difference among these three groups (Fisher's exact probability test, p<0.05)Conclusions: For cervical spondylosis patients who underwent 1-2 segment ACDF, the optimal time period of wearing protective is 5-8 weeks. This time period results in comparable neurological outcome, least axial symptom risk, and highest chance of no deficit on neck function.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

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Optimal Time Period of Wearing Protective Collar After Anterior Cervical Discectomy and Fusion

Qian

Liu

et al. 2020

Preprint

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“…There are different opinions in the literature on the time period of wearing collar after ACDF. Several studies have shown that 1or 2 segment ACDF does not require postoperative external cervical support [4][5][6]. While, other literature reported that patients who underwent 1 or 2 segment ACDF needed wearing collar for 4-12 weeks during offbed ambulation [7][8][9][10].…”

Section: Research Articlementioning

confidence: 99%

Optimal Time Period of Wearing Protective Collar after Anterior Cervical Discectomy and Fusion

Qian¹,

Z²,

Z³

et al. 2021

austinjclincaserep

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Objective: There is still no consensus on the time period of wearing protective collar after Anterior Cervical Discectomy and Fusion (ACDF). We aim to investigate the optimal time period of wearing collar after ACDF. Methods: We retrospectively reviewed patients with cervical spondylosis who underwent one or two segment ACDF during January 2016 and December 2017, and included 97 patients who met inclusion and exclusion criteria. Patients were divided into three groups, 1-4 week group, 5-8 week group and 9-12 week group, according to the actual time period of wearing collar after ACDF. We analyzed Japanese Orthopedic Association (JOA) score, Axial Symptom (AS) score and Neck Disability Index (NDI) before surgery and at post-operative 3 months to investigate the optimal time period of wearing collar after ACDF procedure. Results: 1) JOA score: All three groups have a better post-operative JOA score compared with that before surgery (paired t test, p<0.05). There is no significant difference among the three groups with respect to post-operative JOA (ANOVA, p>0.05). 2) AS score: The post-operative AS scores of 1-4 week group and 5-8 week group were significantly better than that before surgery (paired t test, p>0.05). While the post-operative AS score of 9-12 week group was significantly worse than preoperative AS score (paired t test, p<0.05). 3) NDI: All three groups have a better post-operative NDI compared with that before surgery (McNemar test, p<0.05). Of note, in 5-8 weeks group, the percentage of no deficit increased by 45%, and the percentage of mild deficit decreased by 45% accordingly. That percentage is 26% and 31% in 1-4 week group and 9-12 week group, respectively. There was significant difference among these three groups (Fisher’s exact probability test, p<0.05). Conclusion: For cervical spondylosis patients who underwent 1 or 2 segment ACDF, the optimal time period of wearing protective is 5-8 weeks. This time period results in comparable neurological outcome, least risk of axial symptoms, and highest chance of no deficit with neck function.

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“…Driving restrictions, lifting and activity limitations can significantly affect the postoperative course of patients that may be unable to go back to work and resume their daily activities. To date, scientific evidence of patients' ability to safely resume driving after spinal surgery is rather limited and no clear evidence is available in regards to postoperative restrictions for patients that undergo an ACDF; thus surgeon's recommendations are based on empirical data and personal experience [5].…”

Section: Introductionmentioning

confidence: 99%

Postoperative Restrictions After Anterior Cervical Discectomy and Fusion

Biase¹,

Chen²,

Bydon³

et al. 2020

Cureus

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No scientific evidence on restrictions for patients following an anterior cervical discectomy and fusion (ACDF) is available. The goal of this study is to assess the practice and patterns of restrictions after single-level and multilevel ACDF at an academic institution. We submitted two questionnaires, for restrictions after single-level and multilevel ACDF, to 18 spine surgeons at our institution. Questions included length of time in practice, use of cervical collar, postoperative restrictions and practices. We received 10 complete responses. Four (40%) of the respondents were in practice for less than 5 years; 3 (30%) 5 or more years, but less than 10; 1 (10%) 10 or more years, but less than 20; 2 (20%) 20 or more years. Only two (20%) surgeons recommend a cervical collar after a single-level ACDF, while seven (70%) do so after a multilevel ACDF, for an average of 9.1 weeks and standard deviation (SD) of 2.8. Nine surgeons (90%) reported providing lifting restrictions after a single-level and multilevel ACDF, with a mean of 10 kg and SD of 2.5 in both cases. 5 (50%) give driving restrictions after a single-level ACDF, eight (80%) do so after a multilevel. eight (80%) recommend physical therapy after both single-level and multilevel ACDF. three (30%) obtain a CT to confirm fusion at one year. Only two (20%) recommend a bone stimulator. Significant variability exists among surgeons in regards to restrictions following ACDF, but some areas of consensus emerged: 90% of respondents give lifting restrictions, with a mean of 10 kg, 80% recommend physical therapy for a range of motion and muscle strengthening.

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Utility of Cervical Collars Following Cervical Fusion Surgery. Does It Improve Fusion Rates or Outcomes? A Systematic Review

Cited by 9 publications

References 19 publications

Optimal Time Period of Wearing Protective Collar After Anterior Cervical Discectomy and Fusion

Optimal Time Period of Wearing Protective Collar After Anterior Cervical Discectomy and Fusion

Optimal Time Period of Wearing Protective Collar after Anterior Cervical Discectomy and Fusion

Postoperative Restrictions After Anterior Cervical Discectomy and Fusion

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