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Published in: Journal of Orthopaedic Surgery and Research 1/2024

Open Access 01-12-2024 | Systematic Review

Comparison of outcomes after anterior cervical discectomy and fusion with and without a cervical collar: a systematic review and meta-analysis

Authors: Tingxin Zhang, Gang Gao, Yanhong Li, Feng Gao, Wupeng Yang, Yongjiang Wang, Nana Guo

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

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Abstract

Purpose

The clinical outcomes of patients who received a cervical collar after anterior cervical decompression and fusion were evaluated by comparison with those of patients who did not receive a cervical collar.

Methods

All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 1 October 2023 were included. All outcomes were analysed using Review Manager 5.4.

Results

Four studies with a total of 406 patients were included, and three of the studies were randomized controlled trials. Meta-analysis of the short-form 36 results revealed that wearing a cervical collar after anterior cervical decompression and fusion was more beneficial (P < 0.05). However, it is important to note that when considering the Neck Disability Index at the final follow-up visit, not wearing a cervical collar was found to be more advantageous. There were no statistically significant differences in postoperative cervical range of motion, fusion rate, or neck disability index at 6 weeks postoperatively (all P > 0.05) between the cervical collar group and the no cervical collar group.

Conclusions

This systematic review and meta-analysis revealed no significant differences in the 6-week postoperative cervical range of motion, fusion rate, or neck disability index between the cervical collar group and the no cervical collar group. However, compared to patients who did not wear a cervical collar, patients who did wear a cervical collar had better scores on the short form 36. Interestingly, at the final follow-up visit, the neck disability index scores were better in the no cervical collar group than in the cervical collar group.
PROSPERO registration number: CRD42023466583.
Literature
2.
go back to reference Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr. Anterior cervical discectomy and fusion associated complications. Spine. 2007;32:2310–7.CrossRefPubMed Fountas KN, Kapsalaki EZ, Nikolakakos LG, Smisson HF, Johnston KW, Grigorian AA, Lee GP, Robinson JS Jr. Anterior cervical discectomy and fusion associated complications. Spine. 2007;32:2310–7.CrossRefPubMed
3.
go back to reference Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A(3):607–24.CrossRefPubMed Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A(3):607–24.CrossRefPubMed
4.
go back to reference Drew B, Bhandari M, Orr D, Reddy K, Dunlop RB. Surgical preference in anterior cervical discectomy: a national survey of Canadian spine surgeons. J Spinal Disord Tech. 2002;15(6):454–7.CrossRefPubMed Drew B, Bhandari M, Orr D, Reddy K, Dunlop RB. Surgical preference in anterior cervical discectomy: a national survey of Canadian spine surgeons. J Spinal Disord Tech. 2002;15(6):454–7.CrossRefPubMed
5.
go back to reference Geisler FH, Caspar W, Pitzen T, Johnson TA. Reoperation in patients after anterior cervical plate stabilization in degenerative disease. Spine. 1998;23(8):911–20.CrossRefPubMed Geisler FH, Caspar W, Pitzen T, Johnson TA. Reoperation in patients after anterior cervical plate stabilization in degenerative disease. Spine. 1998;23(8):911–20.CrossRefPubMed
6.
go back to reference Connolly PJ, Grob D. Bracing of patients after fusion for degenerative problems of the lumbar spine–yes or no? Spine. 1998;23(12):1426–8.CrossRefPubMed Connolly PJ, Grob D. Bracing of patients after fusion for degenerative problems of the lumbar spine–yes or no? Spine. 1998;23(12):1426–8.CrossRefPubMed
7.
go back to reference Miller CP, Bible JE, Jegede KA, Whang PG, Grauer JN. The effect of rigid cervical collar height on full, active, and functional range of motion during fifteen activities of daily living. Spine. 2010;35(26):1546–52.CrossRef Miller CP, Bible JE, Jegede KA, Whang PG, Grauer JN. The effect of rigid cervical collar height on full, active, and functional range of motion during fifteen activities of daily living. Spine. 2010;35(26):1546–52.CrossRef
8.
go back to reference Gavin TM, Carandang G, Havey R, Flanagan P, Ghanayem A, Patwardhan AG. Biomechanical analysis of cervical orthoses in flexion and extension: a comparison of cervical collars and cervical thoracic orthoses. J Rehabil Res Dev. 2003;40(6):527–37.CrossRefPubMed Gavin TM, Carandang G, Havey R, Flanagan P, Ghanayem A, Patwardhan AG. Biomechanical analysis of cervical orthoses in flexion and extension: a comparison of cervical collars and cervical thoracic orthoses. J Rehabil Res Dev. 2003;40(6):527–37.CrossRefPubMed
9.
go back to reference Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses; 2013. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, Tugwell P. The Newcastle-Ottawa Scale (NOS) for assessing the quality if nonrandomized studies in meta-analyses; 2013.
10.
go back to reference Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343: d5928.CrossRefPubMedPubMedCentral Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343: d5928.CrossRefPubMedPubMedCentral
11.
go back to reference Campbell MJ, Carreon LY, Traynelis V, Anderson PA. Use of cervical collar after single-level anterior cervical fusion with plate: is it necessary? Spine. 2009;34(1):43–8.CrossRefPubMed Campbell MJ, Carreon LY, Traynelis V, Anderson PA. Use of cervical collar after single-level anterior cervical fusion with plate: is it necessary? Spine. 2009;34(1):43–8.CrossRefPubMed
12.
go back to reference Scerrati A, Visani J, Norri N, Cavallo M, Giganti M, De Bonis P. Effect of external cervical orthoses on clinical and radiological outcome of patients undergoing anterior cervical discectomy and fusion. Acta Neurochir. 2019;161(10):2195–200.CrossRefPubMed Scerrati A, Visani J, Norri N, Cavallo M, Giganti M, De Bonis P. Effect of external cervical orthoses on clinical and radiological outcome of patients undergoing anterior cervical discectomy and fusion. Acta Neurochir. 2019;161(10):2195–200.CrossRefPubMed
13.
go back to reference Abbott A, Halvorsen M, Dedering A. Is there a need for cervical collar usage post anterior cervical decompression and fusion using interbody cages? A randomized controlled pilot trial. Physiother Theory Pract. 2013;29(4):290–300.CrossRefPubMed Abbott A, Halvorsen M, Dedering A. Is there a need for cervical collar usage post anterior cervical decompression and fusion using interbody cages? A randomized controlled pilot trial. Physiother Theory Pract. 2013;29(4):290–300.CrossRefPubMed
14.
go back to reference Overley SC, Merrill RK, Baird EO, Meaike JJ, Cho SK, Hecht AC, Qureshi SA. Is cervical bracing necessary after one- and two-level instrumented anterior cervical discectomy and fusion? A prospective randomized study. Global Spine J. 2018;8(1):40–6.CrossRefPubMed Overley SC, Merrill RK, Baird EO, Meaike JJ, Cho SK, Hecht AC, Qureshi SA. Is cervical bracing necessary after one- and two-level instrumented anterior cervical discectomy and fusion? A prospective randomized study. Global Spine J. 2018;8(1):40–6.CrossRefPubMed
15.
go back to reference Korinth M. Treatment of cervical degenerative disc disease—current status and trends. Zentralbl Neurochir. 2008;69:113–24.CrossRefPubMed Korinth M. Treatment of cervical degenerative disc disease—current status and trends. Zentralbl Neurochir. 2008;69:113–24.CrossRefPubMed
16.
go back to reference Zou S, Gao J, Xu B, Lu X, Han Y, Meng H. Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials. Eur Spine J. 2017;26(4):985–97.CrossRefPubMed Zou S, Gao J, Xu B, Lu X, Han Y, Meng H. Anterior cervical discectomy and fusion (ACDF) versus cervical disc arthroplasty (CDA) for two contiguous levels cervical disc degenerative disease: a meta-analysis of randomized controlled trials. Eur Spine J. 2017;26(4):985–97.CrossRefPubMed
17.
go back to reference He J, Liu Q, Yang Z, Liu H, Wu T, Ding C, Huang K, Wang B. Cervical collar use following anterior cervical hybrid surgery: protocol for a prospective randomized, time-controlled trial. Trials. 2023;24(1):409.CrossRefPubMedPubMedCentral He J, Liu Q, Yang Z, Liu H, Wu T, Ding C, Huang K, Wang B. Cervical collar use following anterior cervical hybrid surgery: protocol for a prospective randomized, time-controlled trial. Trials. 2023;24(1):409.CrossRefPubMedPubMedCentral
18.
go back to reference Jagannathan J, Shaffrey CI, Oskouian RJ, Dumont AS, Herrold C, Sansur CA, Jane JA. Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar. J Neurosurg Spine. 2008;8(5):420–8.CrossRefPubMed Jagannathan J, Shaffrey CI, Oskouian RJ, Dumont AS, Herrold C, Sansur CA, Jane JA. Radiographic and clinical outcomes following single-level anterior cervical discectomy and allograft fusion without plate placement or cervical collar. J Neurosurg Spine. 2008;8(5):420–8.CrossRefPubMed
19.
go back to reference Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602–17.CrossRefPubMed Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg. 1958;15(6):602–17.CrossRefPubMed
20.
go back to reference Chang CJ, Liu YF, Hsiao YM, Huang YH, Liu KC, Lin RM, et al. Comparison of anterior cervical discectomy and fusion versus artificial disc replacement for cervical spondylotic myelopathy: a meta-analysis. J Neurosurg Spine. 2022:1–10. Chang CJ, Liu YF, Hsiao YM, Huang YH, Liu KC, Lin RM, et al. Comparison of anterior cervical discectomy and fusion versus artificial disc replacement for cervical spondylotic myelopathy: a meta-analysis. J Neurosurg Spine. 2022:1–10.
21.
go back to reference Gutman G, Rosenzweig DH, Golan JD. Surgical treatment of cervical radiculopathy: meta-analysis of randomized controlled trials. Spine. 2018;43(6):E365–72.CrossRefPubMed Gutman G, Rosenzweig DH, Golan JD. Surgical treatment of cervical radiculopathy: meta-analysis of randomized controlled trials. Spine. 2018;43(6):E365–72.CrossRefPubMed
22.
go back to reference Ricciardi L, Scerrati A, Olivi A, Sturiale CL, De Bonis P, Montano N. The role of cervical collar in functional restoration and fusion after anterior cervical discectomy and fusion without plating on single or double levels: a systematic review and meta-analysis. Eur Spine J. 2020;29(5):955–60.CrossRefPubMed Ricciardi L, Scerrati A, Olivi A, Sturiale CL, De Bonis P, Montano N. The role of cervical collar in functional restoration and fusion after anterior cervical discectomy and fusion without plating on single or double levels: a systematic review and meta-analysis. Eur Spine J. 2020;29(5):955–60.CrossRefPubMed
23.
go back to reference Karikari I, Ghogawala Z, Ropper AE, Yavin D, Gabr M, Goodwin CR, et al. Utility of cervical collars following cervical fusion surgery. Does it improve fusion rates or outcomes? A systematic review. World Neurosurg. 2018:S1878-8750(18)32889–4. Karikari I, Ghogawala Z, Ropper AE, Yavin D, Gabr M, Goodwin CR, et al. Utility of cervical collars following cervical fusion surgery. Does it improve fusion rates or outcomes? A systematic review. World Neurosurg. 2018:S1878-8750(18)32889–4.
24.
go back to reference King JT Jr, McGinnis KA, Roberts MS. Quality of life assessment with the medical outcomes study short form-36 among patients with cervical spondylotic myelopathy. Neurosurgery. 2003;52(1):113–20.PubMed King JT Jr, McGinnis KA, Roberts MS. Quality of life assessment with the medical outcomes study short form-36 among patients with cervical spondylotic myelopathy. Neurosurgery. 2003;52(1):113–20.PubMed
Metadata
Title
Comparison of outcomes after anterior cervical discectomy and fusion with and without a cervical collar: a systematic review and meta-analysis
Authors
Tingxin Zhang
Gang Gao
Yanhong Li
Feng Gao
Wupeng Yang
Yongjiang Wang
Nana Guo
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI
https://doi.org/10.1186/s13018-024-04661-8

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