The utility of cervical spine bracing as a postoperative adjunct to single-level anterior cervical spine surgery

Ian Caplan; Saurabh Sinha; James Schuster; Matthew Piazza; Gregory Glauser; Benjamin Osiemo; Scott McClintock; William Welch; Nikhil Sharma; Ali Ozturk; Neil Malhotra

doi:10.4103/ajns.AJNS_236_18

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(02): 461-466
DOI: 10.4103/ajns.AJNS_236_18

Original Article

The utility of cervical spine bracing as a postoperative adjunct to single-level anterior cervical spine surgery

Ian Caplan

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

,

Saurabh Sinha

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

,

James Schuster

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

,

Matthew Piazza

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

²Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Laboratory, University of Pennsylvania, Philadelphia

,

Gregory Glauser

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

,

Benjamin Osiemo

³Department of Neurosurgery, McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia

⁴Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, PA

,

Scott McClintock

⁴Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, PA

,

William Welch

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

,

Nikhil Sharma

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

,

Ali Ozturk

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

,

Neil Malhotra

¹Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia

²Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Laboratory, University of Pennsylvania, Philadelphia

› Author Affiliations

Abstract

Background Context: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. Purpose: The purpose of the study is to study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in single-level ACDF. Study Design/Setting: This retrospective cohort analysis of all consecutive patients (n = 578) undergoing single-level ACDF with or without bracing from 2013 to 2017 was undertaken. Methods: Patient demographics and comorbidities were analyzed. Tests of independence (Chi-square, Fisher's exact, and Cochran–Mantel–Haenszel test), Mann–Whitney–Wilcoxon tests, and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility-assisted rehabilitation facility, or skilled nursing facility), quality-adjusted life year (QALY), surgical site infection (SSI), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results: Among the study population, 511 were braced and 67 were not braced. There was no difference in graft type (P = 1.00) or comorbidities (P = 0.06–0.73) such as obesity (P = 0.504), smoking (0.103), chronic obstructive pulmonary disease hypertension (P = 0.543), coronary artery disease (P = 0.442), congestive heart failure (P = 0.207), and problem list number (P = 0.661). LOS was extended for the unbraced group (median 34.00 + 112.15 vs. 77.00 + 209.31 h, P < 0.001). There was no difference in readmission (P = 1.000), ER visits (P = 1.000), SSI (P = 1.000), QALY gain (P = 0.437), and direct costs (P = 0.732). Conclusions: Bracing following single-level cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner. The absence of bracing is associated with increased LOS, but cost analyses show no difference in direct costs between the two treatment approaches. Further evaluation of long-term outcomes and fusion rates will be necessary before definitive recommendations regarding bracing utility following single-level ACDF.

Key-words:

Anterior cervical discectomy and fusion - cervical fixation - single-level bracing

Full Text

References

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