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Oyekan AA, LeVasseur CM, Chen SR, Padmanabhan A, Makowicz N, Donaldson WF, Lee JY, Shaw JD, Anderst WJ. The Effects of Cervical Orthoses on Head and Intervertebral Range of Motion. Spine (Phila Pa 1976) 2023; 48:1561-1567. [PMID: 37339257 DOI: 10.1097/brs.0000000000004755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023]
Abstract
STUDY DESIGN Prospective Cohort. OBJECTIVE Quantify and compare the effectiveness of cervical orthoses in restricting intervertebral kinematics during multiplanar motions. SUMMARY OF BACKGROUND DATA Previous studies evaluating the efficacy of cervical orthoses measured global head motion and did not evaluate individual cervical motion segment mobility. Prior studies focused only on the flexion/extension motion. METHODS Twenty adults without neck pain participated. Vertebral motion from the occiput through T1 was imaged using dynamic biplane radiography. Intervertebral motion was measured using an automated registration process with validated accuracy better than 1 degree. Participants performed independent trials of maximal flexion/extension, axial rotation, and lateral bending in a randomized order of unbraced, soft collar (foam), hard collar (Aspen), and cervical thoracic orthosis (CTO) (Aspen) conditions. Repeated-measures ANOVA was used to identify differences in the range of motion (ROM) among brace conditions for each motion. RESULTS Compared with no collar, the soft collar reduced flexion/extension ROM from occiput/C1 through C4/C5, and reduced axial rotation ROM at C1/C2 and from C3/C4 through C5/C6. The soft collar did not reduce motion at any motion segment during lateral bending. Compared with the soft collar, the hard collar reduced intervertebral motion at every motion segment during all motions, except for occiput/C1 during axial rotation and C1/C2 during lateral bending. The CTO reduced motion compared with the hard collar only at C6/C7 during flexion/extension and lateral bending. CONCLUSIONS The soft collar was ineffective as a restraint to intervertebral motion during lateral bending, but it did reduce intervertebral motion during flexion/extension and axial rotation. The hard collar reduced intervertebral motion compared with the soft collar across all motion directions. The CTO provided a minimal reduction in intervertebral motion compared with the hard collar. The utility in using a CTO rather than a hard collar is questionable, given the cost and little or no additional motion restriction.
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Affiliation(s)
- Anthony A Oyekan
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA
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Caplan IF, Sinha S, Osiemo B, McClintock SD, Schuster JM, Smith H, Glauser G, Sharma N, Ozturk AK, Ali ZS, Malhotra NR. The Utility of Cervical Spine Bracing As a Postoperative Adjunct to Multilevel Anterior Cervical Spine Surgery. Int J Spine Surg 2020; 14:151-157. [PMID: 32355619 DOI: 10.14444/7022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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.
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Affiliation(s)
- Ian F Caplan
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Saurabh Sinha
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Benjamin Osiemo
- McKenna EpiLog Fellowship in Population Health at the University of Pennsylvania, Philadelphia, Pennsylvania.,West Chester University, Department of Mathematics and West Chester Statistical Institute, West Chester, Pennsylvania
| | - Scott D McClintock
- West Chester University, Department of Mathematics and West Chester Statistical Institute, West Chester, Pennsylvania
| | - James M Schuster
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Harvey Smith
- University of Pennsylvania Perelman School of Medicine, Department of Orthopedic Surgery, Philadelphia, Pennsylvania
| | - Gregory Glauser
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Nikhil Sharma
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Ali K Ozturk
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Zarina S Ali
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania
| | - Neil R Malhotra
- University of Pennsylvania Perelman School of Medicine, Department of Neurosurgery, Philadelphia, Pennsylvania.,Translational Spine Research Lab of the University of Pennsylvania, Philadelphia, Pennsylvania
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Analysis of a customized cervical collar to improve neck posture during smartphone usage: a comparative study in healthy subjects. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:1793-1803. [DOI: 10.1007/s00586-019-06022-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/14/2019] [Accepted: 05/27/2019] [Indexed: 11/26/2022]
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Caplan I, Sinha S, Schuster J, Piazza M, Glauser G, Osiemo B, McClintock S, Welch WC, Sharma N, Ozturk A, Malhotra NR. The Utility of Cervical Spine Bracing as a Postoperative Adjunct to Single-level Anterior Cervical Spine Surgery. Asian J Neurosurg 2019; 14:461-466. [PMID: 31143262 PMCID: PMC6516037 DOI: 10.4103/ajns.ajns_236_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Context: Use of cervical bracing/collar subsequent to anterior cervical spine discectomy and fusion (ACDF) is variable. Outcomes data regarding bracing after ACDF are limited. Purpose: The purpose of the study is to study the impact of bracing on short-term outcomes related to safety, quality of care, and direct costs in single-level ACDF. Study Design/Setting: This retrospective cohort analysis of all consecutive patients (n = 578) undergoing single-level ACDF with or without bracing from 2013 to 2017 was undertaken. Methods: Patient demographics and comorbidities were analyzed. Tests of independence (Chi-square, Fisher's exact, and Cochran–Mantel–Haenszel test), Mann–Whitney–Wilcoxon tests, and logistic regressions were used to assess differences in length of stay (LOS), discharge disposition (home, assisted rehabilitation facility-assisted rehabilitation facility, or skilled nursing facility), quality-adjusted life year (QALY), surgical site infection (SSI), direct cost, readmission within 30 days, and emergency room (ER) visits within 30 days. Results: Among the study population, 511 were braced and 67 were not braced. There was no difference in graft type (P = 1.00) or comorbidities (P = 0.06–0.73) such as obesity (P = 0.504), smoking (0.103), chronic obstructive pulmonary disease hypertension (P = 0.543), coronary artery disease (P = 0.442), congestive heart failure (P = 0.207), and problem list number (P = 0.661). LOS was extended for the unbraced group (median 34.00 + 112.15 vs. 77.00 + 209.31 h, P < 0.001). There was no difference in readmission (P = 1.000), ER visits (P = 1.000), SSI (P = 1.000), QALY gain (P = 0.437), and direct costs (P = 0.732). Conclusions: Bracing following single-level cervical fixation does not alter short-term postoperative course or reduce the risk for early adverse outcomes in a significant manner. The absence of bracing is associated with increased LOS, but cost analyses show no difference in direct costs between the two treatment approaches. Further evaluation of long-term outcomes and fusion rates will be necessary before definitive recommendations regarding bracing utility following single-level ACDF.
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Affiliation(s)
- Ian Caplan
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Saurabh Sinha
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - James Schuster
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Matthew Piazza
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Laboratory, University of Pennsylvania, Philadelphia, USA
| | - Gregory Glauser
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Benjamin Osiemo
- Department of Neurosurgery, McKenna EpiLog Fellowship in Population Health, University of Pennsylvania, Philadelphia, USA.,Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, PA, USA
| | - Scott McClintock
- Department of Mathematics, West Chester Statistical Institute, West Chester University, West Chester, PA, USA
| | - William C Welch
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Nikhil Sharma
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Ali Ozturk
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Neil Rainer Malhotra
- Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.,Department of Neurosurgery and Orthopedic Surgery, Translational Spine Research Laboratory, University of Pennsylvania, Philadelphia, USA
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