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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
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
,
Saurabh Sinha
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
,
James Schuster
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
,
Matthew Piazza
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
2   Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Laboratory, University of Pennsylvania, Philadelphia
,
Gregory Glauser
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
,
Benjamin Osiemo
3   Department of Neurosurgery, McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia
4   Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, PA
,
Scott McClintock
4   Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, PA
,
William Welch
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
,
Nikhil Sharma
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
,
Ali Ozturk
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
,
Neil Malhotra
1   Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia
2   Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Laboratory, University of Pennsylvania, Philadelphia
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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

Financial support and sponsorship

The study was financially supported by the Kevin and Bernadette McKenna Family Research Fund.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Saifi C, Fein AW, Cazzulino A, Lehman RA, Phillips FM, An HS, et al. Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the United States from 2006 to 2013. Spine J 2018;18:1022-9.
  • 2 Park Y, Maeda T, Cho W, Riew KD. Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: Sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification. Spine J 2010;10:193-9.
  • 3 Marbacher S, Hidalgo-Staub T, Kienzler J, Wüergler-Hauri C, Landolt H, Fandino J, et al. Long-term outcome after adjacent two-level anterior cervical discectomy and fusion using stand-alone plasmaphore-covered titanium cages. J Neurol Surg A Cent Eur Neurosurg 2015;76:199-204.
  • 4 Yue WM, Brodner W, Highland TR. Long-term results after anterior cervical discectomy and fusion with allograft and plating: A 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976) 2005;30:2138-44.
  • 5 Wang JC, McDonough PW, Endow K, Kanim LE, Delamarter RB. The effect of cervical plating on single-level anterior cervical discectomy and fusion. J Spinal Disord 1999;12:467-71.
  • 6 Samartzis D, Shen FH, Lyon C, Phillips M, Goldberg EJ, An HS, et al. Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion? Spine J 2004;4:636-43.
  • 7 McAnany SJ, Baird EO, Overley SC, Kim JS, Qureshi SA, Anderson PA, et al. Ameta-analysis of the clinical and fusion results following treatment of symptomatic cervical pseudarthrosis. Global Spine J 2015;5:148-55.
  • 8 Panchal RR, Kim KD, Eastlack R, Lopez J, Clavenna A, Brooks DM, et al. Aclinical comparison of anterior cervical plates versus stand-alone intervertebral fusion devices for single-level anterior cervical discectomy and fusion procedures. World Neurosurg 2017;99:630-7.
  • 9 Kaiser MG, Haid RW Jr., Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery 2002;50:229-36.
  • 10 Bible JE, Biswas D, Whang PG, Simpson AK, Rechtine GR, Grauer JN, et al. Postoperative bracing after Spine surgery for degenerative conditions: A questionnaire study. Spine J 2009;9:309-16.
  • 11 Lee JC, Lee SH, Peters C, Riew KD. Adjacent segment pathology requiring reoperation after anterior cervical arthrodesis: The influence of smoking, sex, and number of operated levels. Spine (Phila Pa 1976) 2015;40:E571-7.
  • 12 Shriver MF, Lewis DJ, Kshettry VR, Rosenbaum BP, Benzel EC, Mroz TE, et al. Pseudoarthrosis rates in anterior cervical discectomy and fusion: A meta-analysis. Spine J 2015;15:2016-27.
  • 13 Connolly PJ, Grob D. Bracing of patients after fusion for degenerative problems of the lumbar spine – Yes or no? Spine (Phila Pa 1976) 1998;23:1426-8.
  • 14 Russell DM, Kelleran KJ, Morrison S. Bracing the trunk and neck in young adults leads to a more aged-like gait. Gait Posture 2016;49:388-93.
  • 15 Morrison S, Russell DM, Kelleran K, Walker ML. Bracing of the trunk and neck has a differential effect on head control during gait. J Neurophysiol 2015;114:1773-83.
  • 16 Karlberg M, Magnusson M, Johansson R. Effects of restrained cervical mobility on voluntary eye movements and postural control. Acta Otolaryngol 1991;111:664-70.
  • 17 Sandler AJ, Dvorak J, Humke T, Grob D, Daniels W. The effectiveness of various cervical orthoses. An in vivo comparison of the mechanical stability provided by several widely used models. Spine (Phila Pa 1976) 1996;21:1624-9.
  • 18 Johnson RM, Hart DL, Simmons EF, Ramsby GR, Southwick WO. Cervical orthoses. A study comparing their effectiveness in restricting cervical motion in normal subjects. J Bone Joint Surg Am 1977;59:332-9.
  • 19 Gao F. Effectiveness of adjustable cervical orthoses and modular cervical thoracic orthoses in restricting neck motion: A comparative in vivo biomechanical study. Spine (Phila Pa 1976) 2015;40:E1046-51.
  • 20 Stambolis V, Brady S, Klos D, Wesling M, Fatianov T, Hildner C, et al. The effects of cervical bracing upon swallowing in young, normal, healthy volunteers. Dysphagia 2003;18:39-45.
  • 21 Webber-Jones JE, Thomas CA, Bordeaux RE Jr. The management and prevention of rigid cervical collar complications. Orthop Nurs 2002;21:19-25.
  • 22 Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care 1999;3:347-52.
  • 23 Abbott A, Halvorsen M, Dedering A. Is there a need for cervical collar usage post anterior cervical decompression and fusion using interbody cages? A randomized controlled pilot trial. Physiother Theory Pract 2013;29:290-300.
  • 24 Elliott RE, Tanweer O, Boah A, Morsi A, Ma T, Frempong-Boadu A, et al. Is external cervical orthotic bracing necessary after posterior atlantoaxial fusion with modern instrumentation: Meta-analysis and review of literature. World Neurosurg 2013;79:369-740.
  • 25 Overley SC, Merrill RK, Baird EO, Meaike JJ, Cho SK, Hecht AC, et al. Is cervical bracing necessary after one – And two-level instrumented anterior cervical discectomy and fusion? A prospective randomized study. Global Spine J 2018;8:40-6.
  • 26 Schneider AM, Hipp JA, Nguyen L, Reitman CA. Reduction in head and intervertebral motion provided by 7 contemporary cervical orthoses in 45 individuals. Spine (Phila Pa 1976) 2007;32:E1-6.
  • 27 Zhang S, Wortley M, Clowers K, Krusenklaus JH. Evaluation of efficacy and 3D kinematic characteristics of cervical orthoses. Clin Biomech (Bristol, Avon) 2005;20:264-9.
  • 28 Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958;40-A: 607-24.
  • 29 Campbell MJ, Carreon LY, Traynelis V, Anderson PA. Use of cervical collar after single-level anterior cervical fusion with plate: Is it necessary? Spine (Phila Pa 1976) 2009;34:43-8.
  • 30 Camara R, Ajayi OO, Asgarzadie F. Are external cervical orthoses necessary after anterior cervical discectomy and fusion: A review of the literature. Cureus 2016;8:e688.
  • 31 Zhu MP, Tetreault LA, Sorefan-Mangou F, Garwood P, Wilson JR. Efficacy, safety, and economics of bracing after spine surgery: A systematic review of the literature. Spine J 2018;18:1513-25.
  • 32 Mourning D, Reitman CA, Heggeness MH, Esses SI, Hipp JA. Initial intervertebral stability after anterior cervical discectomy and fusion with plating. Spine J 2007;7:643-6.
  • 33 Yan C, Avadhani NG, Iqbal J. The effects of smoke carcinogens on bone. Curr Osteoporos Rep 2011;9:202-9.
  • 34 Hilibrand AS, Fye MA, Emery SE, Palumbo MA, Bohlman HH. Impact of smoking on the outcome of anterior cervical arthrodesis with interbody or strut-grafting. J Bone Joint Surg Am 2001;83-A: 668-73.
  • 35 Kusin DJ, Ahn UM, Ahn NU. The effect of smoking on spinal cord healing following surgical treatment of cervical myelopathy. Spine (Phila Pa 1976) 2015;40:1391-6.
  • 36 Tetreault LA, Côté P, Kopjar B, Arnold P, Fehlings MG; AOSpine North America and International Clinical Trial Research Network. et al. Aclinical prediction model to assess surgical outcome in patients with cervical spondylotic myelopathy: Internal and external validations using the prospective multicenter AOSpine North American and international datasets of 743 patients. Spine J 2015;15:388-97.
  • 37 Lau D, Chou D, Ziewacz JE, Mummaneni PV. The effects of smoking on perioperative outcomes and pseudarthrosis following anterior cervical corpectomy: Clinical article. J Neurosurg Spine 2014;21:547-58.
  • 38 Yoon ST, Konopka JA, Wang JC, Youssef JA, Meisel HJ, Brodke DS, et al. ACDF graft selection by surgeons: Survey of AOSpine members. Global Spine J 2017;7:410-6.
  • 39 Agabegi SS, Asghar FA, Herkowitz HN. Spinal orthoses. J Am Acad Orthop Surg 2010;18:657-67.
  • 40 Porter ME. What is value in health care? N Engl J Med 2010;363:2477-81.