Is Cervical Bracing Necessary After One- and Two-Level Instrumented Anterior Cervical Discectomy and Fusion? A Prospective Randomized Study.

Abstract

Prospective randomized control trial. To investigate the role of cervical collars in postoperative care following 1- and 2-level instrumented anterior cervical discectomy and fusion (ACDF). The Cervical Spine Research Society Resident Fellow Grant funded this project. Fifty consecutive patients undergoing 1- or 2-level ACDF surgery were randomized into groups receiving either no brace or a cervical brace for 6 weeks postoperatively. Neck Disability Index scores were recorded preoperatively and at regular follow-up visits up to 1 year. Computed tomography scans were read 1 year postoperatively to determine fusion rates, and subsidence was measured as change in middle vertebral distance between initial postoperative and 6-month follow-up lateral cervical radiographs. Twenty-two patients were in the no-brace group, and 22 patients were in the brace group at final follow-up, with an average age of 50 and 55 years, respectively. The no-brace group had a total of 32 operative levels, whereas the brace group had 38 operative levels. There was no statistically significant difference in 1-year postoperative Neck Disability Index scores between the brace (9.30) and no-brace (6.95) groups (<i>P</i> = .28), in 6-month subsidence of all operative levels between the brace (0.85 mm) and no-brace (0.79 mm) groups (<i>P</i> = .72), or in the proportion of fused levels between the brace (89%) and no-brace (97%) groups (<i>P</i> = .37). Our results suggest no advantage in wearing a cervical brace following 1- or 2-level ACDF surgery with respect to 1-year outcome scores, 1-year fusion rates, and 6-month subsidence.