Department of Orthopaedics, The Ohio State Wexner Medical Center, Columbus, Ohio.
Cooper Medical School of Rowan University, Camden, New Jersey.
JBJS Rev. 2024 Sep 16;12(9). doi: e24.00114. eCollection 2024 Sep 1.
The utility and risks associated with the use of cervical collars in the postoperative period after cervical spine surgery have been of debate. The purpose of this study was to systematically review the currently available evidence on the use of cervical collars after cervical spine surgery to assess their impact on outcomes.
A literature search of the PubMed database was performed using keywords "cervical collar," "anterior cervical discectomy and fusion (ACDF)," "posterior cervical decompression and fusion," "laminoplasty," "post-operative orthotic bracing," "cervical decompression," and "cervical orthosis" in all possible combinations. All English studies with the level of evidence of I to IV that were published from May 1, 1986, to December 3, 2023, were considered for inclusion.
A total of 25 articles meeting the inclusion criteria were identified and reviewed. Regarding anterior and posterior fusion procedures, cervical collar use demonstrated improved short-term patient-reported outcomes and pain control. While surgeon motivation for collar use was to increase fusion rates, this is not well drawn out in the literature with the majority of studies demonstrated no significant difference in fusion rates between patients who wore a cervical collar and those who did not. Regarding motion-preserving procedures such as cervical laminoplasty, patients with prolonged postoperative cervical collar use demonstrated increased rates of axial neck pain and decreased final range of motion (ROM).
Surgeon motivation for postoperative cervical collar immobilization after completion of fusion procedures is to increase fusion rates and improve postoperative pain and disability despite this not being fully drawn out in the literature. After completion of motion-sparing procedures, the benefits of collar immobilization diminish with their prolonged use which could lead to increased rates of axial neck pain and decreased ROM. Cervical collar immobilization in the postoperative period should be considered its own intervention, with its own associated risk-benefit profile.
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
颈椎手术后使用颈托的效用和风险一直存在争议。本研究旨在系统回顾目前关于颈椎手术后使用颈托的证据，评估其对结果的影响。
使用关键词“颈托”、“前路颈椎间盘切除融合术（ACDF）”、“后路颈椎减压融合术”、“椎板成形术”、“术后矫形支具”、“颈椎减压”和“颈椎矫形器”在 PubMed 数据库中进行文献检索，对 1986 年 5 月 1 日至 2023 年 12 月 3 日发表的所有可能的组合进行了搜索。纳入所有证据水平为 I 至 IV 级的英文研究。
共确定并回顾了 25 篇符合纳入标准的文章。在前路和后路融合手术中，颈托的使用改善了短期患者报告的结果和疼痛控制。尽管外科医生使用颈托的动机是提高融合率，但文献中并没有很好地阐述这一点，大多数研究表明，佩戴颈托和不佩戴颈托的患者之间的融合率没有显著差异。对于颈椎板成形术等保留运动的手术，术后长时间使用颈托的患者出现颈部轴向疼痛的发生率增加，终末活动范围（ROM）减小。
尽管文献中没有充分阐述，但在完成融合手术后，外科医生对术后颈椎固定的动机是增加融合率，并改善术后疼痛和残疾。在完成运动保留手术后，随着颈托固定时间的延长，其固定的益处减少，这可能导致轴向颈部疼痛发生率增加和 ROM 减小。术后颈托固定应被视为一种独立的干预措施，具有其自身的风险效益特征。
治疗性 III 级。请参阅作者说明，以获取完整的证据等级描述。
