Do You Really Need a Collar After Neck Surgery?

Описание: Collar or No Collar After Neck Surgery

Cervical spine surgery is generally performed if an individual is struggling with radiculopathy (pain and/or weakness in the arm) or myelopathy (symptomatic spinal cord compression). In addition, surgery can be performed for red flag findings (tumour, infection, cord injury, fracture, etc).

There are different types of surgery. We can break it down in terms of first the approach, either from the front or the back (anterior or posterior) and then it can be a simple discectomy/laminectomy/decompression or a discectomy and fusion in which the disc is removed, filled in with a space, and plates and screws are placed to allow fusion occur at those segments. It can also occur across one level or multi-level fusions.

Collars are used to with the assumption that they can foster mproved fusion rates and overall surgical outcomes with the premise that the collar will act as an external cue to limit range of motion in the neck as it heals.

There was a systematic review completed in 2018 by Karikari et al to look at whether collar use can actually improve fusion rates and surgical outcomes, which was the initial impression. It was discussed that given the cost, and impact of collar use on driving, return to work and activity, that they concluded that there is no proven benefit to routine use after elective surgery.

An observational study in 2024. by Shin et al asked this same question. They examined 2 cohorts of patients who underwent ACDF surgery with and without a brace and evaluated radiologically and functionally until 12 months after surgery. The pain score for neck and arm pain was similar and both showed statistically significant improvement when compared with preoperative scores.Thus, it was concluded that using cervical collars does not improve outcome of individuals undergoing one or 2 level ACDF.

There is research to support that wearing a collar can lead to various complications, such as wound issues, difficulty swallowing, respiratory difficulty, muscle wasting and the inability to drive. There is also some level of discomfort with the collars and disability. There is also little biomechanics evidence to support the claim that a brace effective actually reduces motion of the cervical spine.

So with all this research against. Why else do 55% of surgeons reported using it for 1 level surgeries and 76% recommend for multi-level fusions?

Some state that wearing a collar can protect physically against children, pets, strangers, other people. In addition, it provides a reminder and feedback to the patient that you just had a major surgery and you need to slowly ease back into things. Its believed to give comfort to the surgical area and allow the incision to heal as well.

Regardless, the best piece of advice is to follow the instructions of your surgeon. Of course, I am not a surgeon. I am just a Physio. If it’s really uncomfortable or bothersome, see if you can bring this up at your 2 week follow up which is standard for X-rays to assess healing to determine if there is a way to wear it less often or not at all based on the recovery.

Remember, this isn't medical advice. Just education. Please speak to your spine surgeon if you are pending for neck surgery to determine whether wearing a collar is appropriate for you.

Do you have an upcoming neck surgery planned? Have you already had neck surgery? How has your experience been like both wearing and not wearing a collar? Let me know down in the comments below.

Sources

Karikari I, Ghogawala Z, Ropper AE, Yavin D, Gabr M, Goodwin CR, Abd-El-Barr M, Veeravagu A, Wang MC. Utility of Cervical Collars Following Cervical Fusion Surgery. Does It Improve Fusion Rates or Outcomes? A Systematic Review. World Neurosurg. 2018 Dec 26:S1878-8750(18)32889-4. doi: 10.1016/j.wneu.2018.12.066. Epub ahead of print. PMID: 30593959.

Shin, Hong Kyung & Park, Danbi & Jeon, Sang & Roh, Sung & Park, Jin. (2024). Is it necessary to use a cervical brace after single- or double-level ACDF?. Medicine. 103. e38816. 10.1097/MD.0000000000038816.

Educate. Empower. Exercise.

Aleks Physio
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