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  • Compliance Rates for Cervical Collar Use Following Cervical Spinal Fusion: A Prospective Patient Survey and Feasibility study

    Final Number:

    Chad Claus D.O.; Sean D Krieger BSc; Doris Tong MD; Sina Rajamand DO; Teck Mun Soo MD, FRCS(C), FACS; Clifford Michael Houseman DO

    Study Design:

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit 2018

    Introduction: Postoperative immobilization with external cervical orthosis is a common practice following cervical fusions. Its effectiveness is controversial and compliance data is lacking. We sought to evaluate the effect of cervical collar use on fusion rate and we first evaluated collar use compliance as a feasibility study.

    Methods: We prospectively interviewed consecutive patients who underwent anterior/posterior cervical fusion in two hospitals with multiple surgeons at their 2-9 weeks’ postoperative visits from 2/1-8/1/2017. Patients were instructed to wear their cervical collar for at least 23 hours. We excluded personal injuries or patients <18-year-old. Patients were interviewed using a cloud-based, secured and encrypted standardized questionnaire (Fig.1) in person or through a phone interview. Patients were considered lost to follow up after 2 phone calls and 1 certified letter. Our primary outcome is self-reported compliance with collar use. Our secondary outcome is patient comfort rating on a 5-point rating scale. Univariate and sensitivity analyses were used. An equivocal compliance rate will indicate feasibility for a second phase randomized controlled trial to evaluate collar use in cervical fusion.

    Results: Two hundred thirty-eight (86.5%) out of 275 consecutive cervical fusion patients were interviewed. There is no difference between compliant vs. noncompliant patients [Table 1]. One hundred sixty-one (67.7%) patients self-reported collar use compliance with 50.4% wearing for > 23h/day (Table 2 and Fig. 2). Both compliant and noncompliant patients found collar use uncomfortable (Median 4, R=1-5) (Table 3). Sensitivity analysis showed a compliance rate of 45-72%.

    Conclusions: About fifty percent of our patients were non-compliant and the median comfort rate was uncomfortable. Our compliance rate demonstrated that collar use might be of questionable effectiveness in achieving fusion. Further investigation is warranted.

    Patient Care: This feasibility study enables us to proceed with our second phase study to evaluate the effectiveness of external cervical orthosis on fusion rates. The conclusion of which will have a significant impact on patient care and cost.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) understand the compliance rates of external cervical orthosis use, 2) patient-reported comfort level with collar use

    References: 1. George, K. J. & Fehlings, M. G. Is routine postoperative cervical bracing after instrumentation necessary? World Neurosurg. 79, 273–274 (2013). 2. Goel, A. & Kothari, M. External cervical orthosis (ECO): to have or not to have. World Neurosurg. 79, 275–276 (2013). 3. Camara, R., Ajayi, O. O. & Asgarzadie, F. Are External Cervical Orthoses Necessary after Anterior Cervical Discectomy and Fusion: A Review of the Literature. Cureus 8,(7):e688 (2016) 4. Elliott, R. E. et al. Is external cervical orthotic bracing necessary after posterior atlantoaxial fusion with modern instrumentation: meta-analysis and review of literature. World Neurosurg. 79, 369-374–12 (2013). 5. Campbell, M. J., Carreon, L. Y., Traynelis, V. & Anderson, P. A. Use of cervical collar after single-level anterior cervical fusion with plate: is it necessary? Spine 34, 43–48 (2009). 6. 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. 29, 290–300 (2013).

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