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Rigid Cervical Collars after Posterior Cervical Fusion: Do They Improve Outcomes? A Randomized Clinical Trial
Aylar Havazyari1, Amirhossein Kamroo1, Sadegh Bagherzadeh1,2
1Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Objective:
To evaluate whether the postoperative use of a rigid cervical collar after posterior cervical decompression and fusion (PCDF) improves neck pain, functional disability, and quality of life in patients with degenerative cervical myelopathy (DCM).
Materials And Methods:
A single-blind, randomized controlled trial was conducted involving 60 adult patients with magnetic resonance imaging-confirmed DCM undergoing PCDF at two tertiary centers. Participants were randomly assigned to either a rigid cervical collar group ( n = 30) or a no-collar group ( n = 30) postoperatively. Outcomes were measured at 1, 3, 6, and 12 months postsurgery.
Statistical Analysis:
The primary outcome was axial neck pain at 1 month, measured by the visual analog scale (VAS). Secondary outcomes included the neck disability index (NDI) and the 36-Item Short Form Survey (SF-36). Statistical tests included paired t -tests, Mann-Whitney's U tests, and repeated-measures analysis of variance, with all data analysis performed by investigators blinded to group allocation. Post hoc power analysis was conducted to assess statistical sensitivity.
Results:
Both groups experienced significant improvements in VAS, NDI, and SF-36 scores over time. However, there were no statistically significant differences between the collar and no-collar groups at any measured time point. At 1 month, mean VAS scores were 4.30 ± 0.75 (collar) and 4.07 ± 0.58 (no collar; p = 0.233). Gains in disability and quality-of-life measures surpassed minimal clinically important differences for both groups, but without significant between-group differences. The trial was underpowered (post hoc power = 26.4%) to detect small-to-moderate differences; therefore, outcomes should be interpreted cautiously.
Conclusion:
The use of a rigid cervical collar after PCDF did not confer additional benefit for neck pain, functional outcomes, or quality of life compared with no collar. These findings suggest that routine rigid cervical collar prescription after PCDF should be reconsidered. Given the study's limited statistical power (26.4%) and lack of surgeon/patient blinding, findings should be interpreted cautiously.