General Session: Cervical Degenerative
Presented by: S. Overley - View Audio/Video Presentation (Members Only)
S. Overley(1), R. Merrill(1), E. Baird(1), J. Meaike(1), S. Cho(1), A. Hecht(1), S. Qureshi(1)
(1) Icahn School of Medicine at Mount Sinai, New York, NY, United States
Background: Anterior cervical discectomy and fusion (ACDF) is indicated to treat degenerative conditions of the cervical spine. Graft non-union 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 objective of this prospective randomized controlled trial was to investigate the role of cervical collars in post-operative care following one and two level instrumented anterior cervical discectomy and fusion ACDF.
Methods: The Cervical Spine Research Society Resident Fellow Grant funded this project. Fifty consecutive patients undergoing one or two level ACDF surgery were randomized into a group receiving no brace or a group receiving a cervical brace for 6 weeks postoperatively. Neck Disability Index (NDI) scores were recorded pre-operatively 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 6 month follow up lateral cervical radiographs. Continuous variables between groups were compared with an unpaired t-test, and nominal variables were compared with a Fisher's exact test.
Results: We had 44 patients remaining in the study at final follow-up. Twenty-two patients were in the no-brace group and 22 patients in the brace group, with an average age of 50 and 55, respectively. The no-brace group had a total of 32 operative levels, while the brace group had 38 operative levels. There was no statistically significant difference in post-op NDI scores between brace (10.06 ± 7.20) and no-brace (7.28 ± 7.54) group (p=0.27), in subsidence of all operative levels between the brace (0.85mm ± 0.45) and no-brace (0.79mm ± 0.43) group (p=0.72), or in the proportion of fused levels between the brace (89%) and no-brace (97%) group (p=0.37).
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.