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  • The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery

    Final Number:

    Ian Caplan; Saurabh Sinha MD; James M. Schuster MD, PhD; Matthew Piazza MD; William Charles Welch MD, FACS, FICS; Nikhil Sharma; Ali Kemal Ozturk MD; Neil R. Malhotra MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. Here, we study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in single-level ACDF.

    Methods: Retrospective cohort analyses of all consecutive patients undergoing single-level ACDF with or without bracing from 2013-2017 was undertaken (n=578). Patient demographics and comorbidities were analyzed. Tests of independence (Chi-square, Fisher’s exact test, Cochran-Mantel-Haenszel), Mann-Whitney-Wilcoxon tests, and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility-ARF, or skilled nursing facility-SNF), quality-adjusted life year (QALY), surgical-site-infection (SSI), direct cost, readmission within 30 days, and ER visits within 30 days.

    Results: Amongst the study population, 511 were braced and 67 were not braced. There was no difference in graft type (P=1.000) or comorbidities (P=0.06-0.73) such as obesity (P=0.504), smoking (P=0.103), chronic obstructive pulmonary disease (P=0.0613), 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 hr., 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 post-operative 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 prior to definitive recommendations regarding bracing utility following single-level ACDF.

    Patient Care: By the conclusion of this session, participants should be able to: 1) Understand the impact on LOS by utilization of bracing after ACDF, 2) Understand the impact of direct costs between bracing and no bracing.

    Learning Objectives: Utilization of post-operative bracing after ACDF did not decrease the risks of adverse events or costs, but is associated with decreased LOS.


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