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Effect of external cervical orthoses on clinical and radiological outcome of patients undergoing anterior cervical discectomy and fusion

  • Original Article - Spine degenerative
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Abstract

Background

The current use of external cervical orthoses (ECO) after cervical discectomy is still based on a common practice than a solid scientific literature. The aim of this study is to evaluate the impact of ECO on radiological and functional outcomes in patients undergoing anterior cervical discectomy and fusion (ACDF).

Methods

We compared two cohorts of consecutive patients who underwent ACDF with and without ECO after surgery. Thirty-six patients operated from January 2015 to June 2016 received an ECO whereas 36 patients, operated from July 2016 to December 2017, did not. Each patient underwent radiological and functional evaluation using plain x-ray at 1, 6, and 12 months after surgery and Neck Disability Index (NDI) at 2 weeks and 3, 6, and 12 months after surgery, respectively.

Results

In the ECO group, 5 patients (13.9%) presented an incomplete fusion and 31 patients (86.1%) presented a complete fusion (CI 0.705–0.953). In the non-ECO group, 8 patients (22.2%) presented an incomplete fusion and 28 patients (77.8% [CI 0.608–0.899]) had a complete fusion, with no statistically significant differences between two groups. No statistically significant differences were also observed regarding the NDI neither at 2 weeks nor at 3-, 6-, and 12-month follow-up. At multivariate analysis, patients who underwent two-level ACDF showed a five-fold increased risk of worse NDI at 3-, 6-, 12-month (p = 0.003, CI 1.770–14.584) follow-up.

Conclusions

We advise against the routine use of ECO after single- or two-level ACDF as we did not find out any significant statistical differences between the two groups.

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Acknowledgments

The authors wish to thank the statisticians Giorgia Valpiani (ACQUARI, University Hospital of Ferrara) and Elisa Maietti (Department of Biomedical and Neuromotor Sciences, University of Bologna; Center of Clinical Epidemiology, Department of Medical Sciences, University of Ferrara) for their precious help with interpretation of statistical analyses.

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Author notes

  1. A. Scerrati and Jacopo Visani contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, S. Anna University Hospital, Ferrara, Italy

    A. Scerrati, Jacopo Visani, N. Norri, M. Cavallo & P. De Bonis

  2. Department of Radiology, S. Anna University Hospital, Ferrara, Italy

    M. Giganti

Authors
  1. A. Scerrati
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  2. Jacopo Visani
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  3. N. Norri
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  4. M. Cavallo
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  5. M. Giganti
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  6. P. De Bonis
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Correspondence to Jacopo Visani.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Ethical Committee of Ferrara University and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Ethical Committee of Ferrara University Hospital (Ethics CE-AVEC number 55/2019/Oss/AOUFe).

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Informed consent was obtained from all individual participants included in the study.

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This article is part of the Topical Collection on Spine degenerative

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Scerrati, A., Visani, J., Norri, N. et al. Effect of external cervical orthoses on clinical and radiological outcome of patients undergoing anterior cervical discectomy and fusion. Acta Neurochir 161, 2195–2200 (2019). https://doi.org/10.1007/s00701-019-04046-5

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  • DOI: https://doi.org/10.1007/s00701-019-04046-5

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