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Research ArticleCervical Spine

The Utility of Cervical Spine Bracing As a Postoperative Adjunct to Multilevel Anterior Cervical Spine Surgery

Ian F. Caplan, Saurabh Sinha, Benjamin Osiemo, Scott D. McClintock, James M. Schuster, Harvey Smith, Gregory Glauser, Nikhil Sharma, Ali K. Ozturk, Zarina S. Ali and Neil R. Malhotra
International Journal of Spine Surgery April 2020, 7022; DOI: https://doi.org/10.14444/7022
Ian F. Caplan
1University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
BS
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Saurabh Sinha
1University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
MD
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Benjamin Osiemo
2McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, Pennsylvania
3West Chester University, Department of Mathematics and West Chester Statistical Institute, West Chester, Pennsylvania
MS
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Scott D. McClintock
3West Chester University, Department of Mathematics and West Chester Statistical Institute, West Chester, Pennsylvania
PHD
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James M. Schuster
1University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
MD, PHD
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Harvey Smith
4University of Pennsylvania Perelman School of Medicine, Department of Orthopedic Surgery, Philadelphia, Pennsylvania
MD
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Gregory Glauser
1University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
BS
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Nikhil Sharma
1University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
BS
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Ali K. Ozturk
1University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
MD
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Zarina S. Ali
1University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
MD
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Neil R. Malhotra
1University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
5Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, Pennsylvania
MD
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ABSTRACT

Background 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 multilevel ACDF.

Methods Retrospective cohort analyses of all consecutive patients undergoing multilevel ACDF with or without bracing from 2013 to 2017 was undertaken (n = 616). Patient demographics and comorbidities were analyzed. Tests of independence 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), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days.

Results Amongst the study population, 553 were braced and 63 were not braced. There was no difference in comorbidities (P > .05) such as obesity, smoking, chronic obstructive pulmonary disease, hypertension, coronary artery disease, congestive heart failure, and problem list number. A significant difference in American Society of Anesthesiologists (ASA) score was found, with more ASA 2 patients in the braced cohort and more ASA 3 patients in the unbraced cohort (P = .007). LOS was extended for the unbraced group (median 156.9 ± 211.4 versus 86.67 ± 130.6 h, P = .003), and ER visits within 30 days were 0.21 times less likely in the braced group (P = .006). There was no difference in readmission (P = .181), QALY gain (P = .968), and direct costs (P = .689).

Conclusion Bracing following multilevel cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner.

  • multilevel bracing
  • cervical fixation
  • anterior cervical discectomy and fusion (ACDF)

Footnotes

  • Disclosures and COI: The authors have no disclosures to report.

  • ©International Society for the Advancement of Spine Surgery
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International Journal of Spine Surgery: 19 (S2)
International Journal of Spine Surgery
Vol. 19, Issue S2
1 Apr 2025
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The Utility of Cervical Spine Bracing As a Postoperative Adjunct to Multilevel Anterior Cervical Spine Surgery
Ian F. Caplan, Saurabh Sinha, Benjamin Osiemo, Scott D. McClintock, James M. Schuster, Harvey Smith, Gregory Glauser, Nikhil Sharma, Ali K. Ozturk, Zarina S. Ali, Neil R. Malhotra
International Journal of Spine Surgery Apr 2020, 7022; DOI: 10.14444/7022

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The Utility of Cervical Spine Bracing As a Postoperative Adjunct to Multilevel Anterior Cervical Spine Surgery
Ian F. Caplan, Saurabh Sinha, Benjamin Osiemo, Scott D. McClintock, James M. Schuster, Harvey Smith, Gregory Glauser, Nikhil Sharma, Ali K. Ozturk, Zarina S. Ali, Neil R. Malhotra
International Journal of Spine Surgery Apr 2020, 7022; DOI: 10.14444/7022
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Keywords

  • multilevel bracing
  • cervical fixation
  • anterior cervical discectomy and fusion (ACDF)

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