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Current Trends in the Use of Cervical Collar Immobilization After Cervical Spine Surgery: A Global Survey Analysis
Ricardo J Fernández de-Thomas1, Samuel Adida2, Michael B Cloney1
1Department of Neurological Surgery, University of Pittsburgh Medical Center.
Study Design:
We surveyed spine surgeons regarding their postoperative usage of cervical collars.
Objective:
This study aimed to survey an extensive population of attending physicians and trainees to explore the current trends in the use of cervical collar immobilization after cervical spine surgery.
Summary Of Background Data:
Practice patterns for using cervical collars vary widely following cervical spine surgery.
Methods:
An online survey was created and distributed to neurosurgical and orthopedic residents, spine fellows, and attending surgeons. Demographic characteristics of the respondents were obtained. The anonymous survey consisted of 19 questions addressing indications for use of a cervical collar, its rationale, and duration of use. Responses were evaluated with percent agreement and inter-rater reliability as measured by Gwet's AC1. For individual questions, the proportion of positive answers was compared with the proportion expected by chance alone.
Results:
Three hundred forty participants from 39 states in the United States and 41 countries responded to the survey. The percent agreement across all questions was greater than the 50% expected by chance alone [58% (56.5%, 58.5%)] and there was modest inter-rater reliability (Gwet AC=0.23, P <0.001). Providers' decisions to use a collar varied significantly by pathology ( P <0.0001), procedure performed ( P <0.0001), duration of use ( P <0.0001), and rationale for use ( P <0.0001). The presentation for which there was most agreement to use collars was trauma (81%), the greatest agreement not to use collars was infection (19%), and the lowest rate of agreement was neoplasm [48% (42.3%, 53.0%)]. Collars were utilized most often following multilevel corpectomy [2+levels, 74% (69.1%, 78.5%)], least often following disc arthroplasty [13% (9.6%, 16.9%)], and the lowest rate of agreement was seen for 1-2 level posterior cervical fusion [44% (38.5%, 49.1%)]. The most common rationales for using a collar were to limit the patient's activity (56%), support arthrodesis (47%), and reduce pain (41%).
Conclusions:
The use of cervical collars is controversial, and providers' practices vary significantly. These findings underscore the need for evidence-based recommendations to guide clinical practice.