Is it necessary to use a cervical brace after single- or double-level ACDF?

Abstract

Although anterior cervical discectomy and fusion (ACDF) is one of the most frequently performed spinal surgeries, there is no consensus regarding the necessity of prescribing a cervical brace after surgery. This study aimed to investigate any difference in radiological and clinical outcomes when wearing or not wearing cervical braces after single- or double-level ACDF. We examined 2 cohorts of patients who underwent single- or double-level ACDF surgery with and without a cervical brace: patients who underwent ACDF between March 2018 and December 2019 received a cervical brace, while patients who underwent ACDF between January 2020 and May 2021 did not. Each patient was evaluated radiologically and functionally using plain X-ray, modified Japanese Orthopedic Association score, and visual analog scale for neck and arm until 12 months after surgery. Fusion rate, subsidence, and postoperative complications were also evaluated. Eighty-three patients were included in the analysis: 38 were braced and 45 were not. The demographic characteristics and baseline outcome measures of both groups were similar. There was no statistically significant difference in any of the clinical measures at baseline. The modified Japanese Orthopedic Association score and visual analog scale for neck and arm were similar in both groups at all time intervals and showed statistically significant improvement when compared with preoperative scores. In addition, fusion rate, subsidence, and postoperative complications were similar in both groups. Our results suggest that the use of cervical braces does not improve the clinical outcomes of individuals undergoing single- or double-level ACDF.

Figure 1.

The segmental height was assessed at the lateral cervical X-rays. It was measured between the midpoint of the superior endplate of the upper vertebral body and the midpoint of the inferior endplate of the lower vertebral body. (A) Immediate postoperative X-ray (within 2 days after surgery) and (B) 12 months postoperative X-ray. This patient received C4-5 ACDF and was assessed to have subsidence as the segmental height loss was >2 mm at 12-month follow-up compared to the immediate postoperative state. ACDF = anterior cervical discectomy and fusion.

Figure 2.

Functional outcomes in the brace and non-brace groups at different time intervals. General pattern of the variation of the functional outcomes assessed through a linear mixed model in each group was not statistically different in (A) mJOA (P = .24), (B) VAS-neck (P = .46), and (C) VAS-arm (P = .10). mJOA = modified Japanese Orthopedic Association; VAS = visual analog scale. ^†Statistically significant difference from the preoperative scores in the brace group. ^‡Statistically significant difference from the preoperative scores in the non-brace group.