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Presentation #1: Is Cervical Bracing Necessary after Single and Multi‐Level Anterior Cervical Discectomy and Fusion? A Prospective Randomized Study

Overley, Samuel C. MD; Merrill, Robert K. BS; Baird, Evan O. MD; Cho, Samuel K. MD; Cliffs, Englewood NJ; Hecht, Andrew C. MD; Qureshi, Sheeraz A. MBA, MD

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Spine Journal Meeting Abstracts: 2016 - Volume 2016 - Issue - p 92–93
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Study Design: Prospective randomized controlled trial.

Introduction: ACDF is on of the most common procedures performed on the cervical spine. Graft nonunion and subsidence are complications of the procedure. Rigid cervical collars restrict cervical motion post‐operatively in an attempt to prevent such complications, but there is controversy regarding their effectiveness. The purpose of this study is to determine what effect, if any, cervical bracing after ACDF has on rates of subsidence, fusion, and patient reported outcomes.

Methods: The Cervical Spine Research Society Resident Fellow Grant funded this project. Thirtythree consecutive patients undergoing one or two level ACDF surgery were randomized into a group receiving no brace or group receiving a cervical brace for 6 weeks post‐operatively. Neck Disability Index (NDI) scores were recorded preoperatively and at 24 months follow‐up as a clinical outcome measure. Computed Tomography scans were read 1 year post‐operatively to determine fusion rates, and subsidence was measured on follow up lateral cervical radiographs.

Results: Twenty‐two patients were in the no‐brace group and 22 patients in the brace group, with an average age of 49 and 54, respectively. The no‐brace group had a total of 31operative levels, while the brace group had 33 operative levels. There was no statistically significant difference in post‐op NDI scores between brace (11.56 ± 8.62) and no‐brace (7.28 ± 7.54) group (p = 0.1969), as shown in Figure 1. There was no difference in subsidence of all operative levels between the brace (1.62mm ± 0.62) and no‐brace (1.44mm ± 0.88) group (p = 0.5739), shown in figure 2. Additionally, there was no difference in the fusion rates between the brace (87%) and no‐brace (95%) group (p = 0.5768).

Figure 1
Figure 1:
Figure 1. Histogram comparing average pre and post‐operative NDI scores between groups with and without a cervical brace. Histograms demonstrate the mean of each group and error bars indicate the standard deviation. The * symbol indicates significant differences

Conclusions: Our results suggest no advantage in wearing a cervical brace following one or two level ACDF surgery. There is a trend towards improved NDI scores, less subsidence, and increased fusion rates in patients who did not wear a cervical brace during the post‐operative period, though these results lack statistical significance.

Figure 2
Figure 2:
Figure 2. Points comparing the average subsidence of 1st level fused, 2nd level fused, and total subsidence for multi level fusions of patients with and without a cervical brace. Error bars indicate standard deviation.
© 2016 Lippincott Williams & Wilkins, Inc.