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Not bracing patients after one-level plated ACDF deemed safe, effective

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TORONTO — Patients demonstrate similar clinical results and return-to-work and fusion rates whether or not they wear a cervical collar or brace following plated cervical spine fusion, according to a study conducted by investigators at three U.S. centers.

Other than some minor differences noted in their Neck Disability Index (NDI) scores early on in the study, both groups’ results following anterior cervical disc fusion (ACDF) were highly similar, Mitchell J. Campbell, MD, said. He presented the results here at the North American Spine Society 23rd Annual Meeting.

“I think it shows that the brace is unnecessary for a single-level ACDF,” Campbell said, noting that plates should theoretically preclude the need for using any kind of bracing to restrict neck motion postoperatively. Many surgeons still prescribe cervical braces more out of habit than need, he added.

The 257 patients included in the study were part of the control or fusion arm of an FDA cervical total disc arthroplasty study. All of the patients were treated with anterior plated fusion with allograft bone and were similar in terms of demographics and baseline parameters. Following the surgery, 149 patients wore braces vs. 108 patients who did not.

Investigators studied results in both groups using the SF-36, NDI and the numeric scale for assessing preoperative arm or neck pain (0-20). Patients were followed up at five time points between 1.5 and 24 months postop.

At the 6-, 12- and 24-month follow-ups, researchers analyzed their radiographs to determine fusion rates based on evidence of bridging bone seen in the area treated.

Reference:

• Campbell MJ, Carreon LY, Traynelis VC, Anderson PA. Is a cervical collar after anterior cervical fusion with plating necessary? Paper #63. Presented at the North American Spine Society 23rd Annual Meeting. Oct. 15-18, 2008. Toronto. Campbell receives royalties and research support from and is a paid consultant to Medtronic.