Abstract
Purpose
This study aimed to assess the preferences of spine surgeons in Heilongjiang Province regarding the duration of cervical collar use after single-level anterior cervical discectomy and fusion (ACDF) and to identify the factors influencing these preferences.
Methods
A cross-sectional survey was conducted in Heilongjiang Province from August 4 to August 11, 2024. A convenience sampling method was employed to survey 96 spine surgeons via an online questionnaire. Factors influencing the duration of cervical collar use were analysed via chi-square tests and binary logistic regression.
Results
Significant variation in the duration of cervical collar use was observed after single-level ACDF, with the shortest duration being no use (2.08%) and the longest being 12 weeks (4.17%). The most common duration was 3 weeks (65.63%). The factors influencing the duration of cervical collar use included the surgeon’s education level (χ²=10.902, P < 0.001), years of practice (χ²=12.565, P = 0.006), and annual case volume of single-level ACDF (χ²=9.438, P = 0.009). Notably, years of practice was identified as an independent factor influencing the duration of cervical collar use (OR = 0.572, 95% CI: 0.348~0.939; P = 0.027).
Conclusions
This survey shows that there are differences in the clinical practices of spine surgeons in Heilongjiang Province regarding the duration of cervical collar wearing after single-level ACDF. These research findings suggest the need to develop standardized guidelines and consensus, alongside improved postoperative health education, to reduce the related complications caused by the long-term use of cervical collars in patients, such as axial symptoms, and to improve patients’ quality of life after surgery.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12891-025-08880-w.
Keywords: Anterior cervical discectomy and fusion, Cervical collar, Spine surgeon, Cross-sectional survey, Immobilization duration
Introduction
Cervical spondylosis refers to degenerative changes in the cervical spine [ 1 ], with a prevalence rate of 13.76% [ 2 ]. This disease mainly affects the elderly population, among whom the prevalence rate among those aged 65 and above is as high as 70% [ 3 ]. However, its incidence rate among young people is also on the rise [ 4, 5 ]. The main clinical manifestations of cervical spondylosis include neck pain, etc [ 6 ]. Moreover, neck pain is one of the top ten causes of disability-adjusted life years globally [ 7 ]. The treatment methods for cervical spondylosis include drug therapy, conservative treatment, and surgical treatment [ 8 ]. When symptoms worsen or conservative treatment is ineffective, surgical treatment is usually adopted [ 3 ]. Anterior cervical decompression and fusion (ACDF) is the most common surgical intervention for treating cervical spondylosis [ 9, 10 ]. In the United States, the annual number of ACDF surgeries exceeds 130,000 cases, and this figure is still increasing [ 11 ]. Research has found that the lifetime total cost of ACDF treatment for each patient with cervical spondylosis ranges from $73,329 to $83,572 [ 12 ]. Overall, cervical spondylosis not only affects the quality of life of patients but also increases their economic burden [ 2 ].
After ACDF surgery, surgeons usually require patients to wear a cervical collar [13]. Cervical collar is a neck brace used to fix the cervical spine and is an important auxiliary means for patient rehabilitation [14]. However, currently, there are no standardized guidelines or expert consensus on its use both at home and abroad [15, 16], which leads to inconsistencies in clinical practice. The purpose of this study is to conduct an investigation in this regard.
It is worth noting that there are still controversies regarding the advantages and disadvantages of using a cervical collar and the optimal wearing duration [17]. Proponents of cervical collar use argue that it limits cervical movement, improves fusion rates, and provides additional spinal stability [18, 19]. In contrast, opponents contend that the use of anterior cervical plate fixation reduces the need for external support [10, 20]. Prolonged cervical collar use has been associated with complications such as dysphagia, pressure sores, and decreased cervical range of motion [9, 20–23]. Axial symptoms, which include soreness, weakness, swelling, stiffness, and restricted movement in the neck and shoulders, significantly impair postoperative quality of life. Studies have shown that avoiding the use of a cervical collar after ACDF can reduce the incidence of these axial symptoms [9]. Therefore, the current use of a cervical collar largely depends on the personal preferences and experience of surgeons [10, 24], highlighting the urgency of evidence-based standardized guidance.
Existing studies have focused primarily on spine surgeons’ preferences regarding cervical collar use post-ACDF [25–27], yet few have explored the factors influencing these preferences. Since single-level ACDF is the most common type of cervical spine surgery [28], this study investigated the duration of cervical collar use and the factors influencing this decision among spine surgeons in Heilongjiang Province, China. It is hoped that industry scholars will pay more attention to the relevant issues of cervical collar use after ACDF, especially the adverse reactions such as neck pain caused by cervical collar use, so as to help improve the quality of life of patients after surgery. Subsequently, based on the results of this survey, the research team will conduct a prospective clinical controlled trial. Through scientific and rigorous clinical comparative studies, the optimal duration of cervical collar use after ACDF will be determined, providing a solid evidence-based medical basis for the formulation of clinical practice guidelines and industry consensus.
Methods
Study area and period
This cross-sectional survey of spinal surgeons was conducted in Heilongjiang Province, in northeastern China. The survey took place from August 4 to August 11, 2024, coinciding with the “Belt and Road” Northeast Asia Rehabilitation Medicine Forum-Orthopedic Progress Seminar.
Study design
A convenience sampling method was employed to survey spine surgeons in Heilongjiang Province to understand their preferences regarding the duration of cervical collar use following single-level ACDF, as well as the factors influencing these preferences. Previous studies have shown that researchers generally consider the use of a cervical collar for 4 weeks after ACDF as an independent grouping [29, 30]. Based on this, in this study, the data on the duration of cervical collar use collected were transformed into a dichotomous variable. Taking 4 weeks as the grouping threshold, it was divided into two groups: the group with a cervical collar use duration of ≤ 4 weeks and the group with a cervical collar use duration of > 4 weeks. In addition, the questionnaire was developed by the research team on the basis of a global literature review on the subject. The survey consisted of 15 items divided into two sections: demographic information about the surgeons and factors related to cervical collar use after single-level ACDF, including the surgeon’s age, education level, and years of practice. The full survey is detailed in the appendix.
Inclusion and exclusion criteria
The inclusion criteria were as follows: (1) spine surgeons practicing in medical institutions in Heilongjiang Province; (2) spinal surgeons who are capable of independently performing and have already carried out ACDF surgery; and (3) surgeons who voluntarily agreed to participate in the study.
The exclusion criterion was that the retired spine surgeons no longer practice in a clinical setting. In addition, strict exclusion criteria were set for questionnaires: those who were incomplete or who took less than 150 s to answer the questionnaire were excluded. Among them, the time threshold of 150 s is the baseline time determined by the investigator to complete the questionnaire as quickly as possible through multiple simulation experiments.
Data collection
During the academic conference, participants scanned QR codes to complete and submit the survey. Those who did not attend the conference were invited to participate by the secretary of the Orthopaedic Professional Committee of Heilongjiang Medical Association, who distributed the online questionnaire via Wenjuanxing. Each participant was permitted to submit only one response.
Sample size calculation
The sample size was estimated via Kendall’s method for descriptive research [31]: Sample size (N) = Number of items in the questionnaire (n) × 5 ∼ 10 times. Given the 15 items in the questionnaire and accounting for a 20% invalid response rate, the required sample size ranged from 90 to 180. The final sample size in this study was 96 participants.
Ethical considerations
The study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University (No. 2024339). All participants provided informed consent electronically after reading the statement explaining the study’s purpose.
Statistical analysis
The data were carefully checked and entered into Excel spreadsheets for organization and subsequently imported into SPSS 27.0 software for statistical analysis. The normality of continuous variables was assessed. Normally distributed data are described as the mean ± standard deviation (
±SD), whereas nonnormally distributed data are described as the median and interquartile range (M [P25, P75]). Categorical data are presented as frequencies and percentages (%). Comparisons between groups were performed via chi-square tests or Fisher’s exact test. The duration of cervical collar use was regarded as a binary variable, with 4 weeks set as the grouping threshold value, and then analyzed by binary logistic regression. A p-value of < 0.05 was considered to indicate statistical significance.
Results
Demographic characteristics of spine surgeons
A total of 119 questionnaires were collected, and after excluding invalid responses (incomplete forms or those submitted in less than 150 s), 96 valid responses remained, yielding a valid response rate of 80.67%. Among the respondents, 95 were male (98.96%), 51 were aged between 30 and 50 years (53.13%), 69 held a master’s degree or lower (71.9%), 73 were chief physicians (76.04%), and 67 had over 20 years of clinical experience (69.79%). The participants were from 39 different medical institutions, with the majority representing tertiary Grade A hospitals (84, 87.5%). The detailed demographic data are presented in Table 1.
Table 1.
Demographic data of spine surgeons and characteristics of cervical collar use Duration(N = 96)
| Characteristic | Number | Percentage (%) |
|---|---|---|
| Gender | ||
| Male | 95 | 98.96 |
| Female | 1 | 1.04 |
| Age | ||
| < 30 years | 1 | 1.04 |
| 30 ∼ 50 years | 51 | 53.13 |
| 51 ∼ 70 years | 44 | 45.83 |
| Education level | ||
| Master’s degree or below | 69 | 71.9 |
| Doctorate | 27 | 28.1 |
| Title | ||
| Resident | 1 | 1.04 |
| Attending physician | 5 | 5.21 |
| Associate chief physician | 17 | 17.71 |
| Chief physician | 73 | 76.04 |
| Years of Practice | ||
| ≤ 5 years | 2 | 2.08 |
| 6 ∼ 10 years | 6 | 6.25 |
| 11 ∼ 15 years | 10 | 10.42 |
| 16 ∼ 20 years | 11 | 11.46 |
| > 20 years | 67 | 69.79 |
| Hospital Level | ||
| Tertiary grade-A hospitals | 84 | 87.5 |
| Other hospitals | 12 | 12.5 |
| Years of ACDF Experience | ||
| ≤ 5 years | 23 | 23.95 |
| 6 ∼ 10 years | 22 | 22.92 |
| 11 ∼ 15 years | 22 | 22.92 |
| 16 ∼ 20 years | 11 | 11.46 |
| > 20 years | 18 | 18.75 |
| Annual ACDF Case Volume | ||
| < 50 surgeries | 63 | 65.62 |
| 50 ∼ 100 surgeries | 17 | 17.71 |
| > 100 surgeries | 16 | 16.67 |
| Graft Type | ||
| PEEK cage | 75 | 78.13 |
| Autograft (iliac crest bone) | 20 | 20.83 |
| Other | 1 | 1.04 |
| Cervical Collar Material | ||
| Soft collar (foam) | 51 | 53.12 |
| Hard collar (plastic, metal) | 45 | 46.88 |
| Can cervical collar be avoided after single-level ACDF? | ||
| Yes | 52 | 54.17 |
| No | 44 | 45.83 |
Cervical collar use duration and related factors
The median and interquartile ranges of “length of cervical collar use after single-level ACDF” are 3 weeks. The shortest reported duration was no use at all, whereas the longest was 12 weeks. The most common duration was 3 weeks (65.63%). Among the surgeons, 51 (53.13%) preferred soft cervical collars. The primary reasons for recommending cervical collar use included providing support to reduce cervical spine pressure and alleviate neck pain (73 surgeons), limiting excessive postoperative cervical movement (73 surgeons), promoting implant fusion (65 surgeons), offering psychological safety and protection for the cervical spine (61 surgeons), maintaining the normal physiological curvature of the cervical spine (57 surgeons), relieving pain due to postoperative soft tissue swelling (54 surgeons), and reducing graft subsidence (53 surgeons). Additionally, 52 surgeons (54.17%) believed that the use of cervical collars could be avoided after single-level ACDF. The health education content for patients who do not use cervical collars post-surgery is shown in Fig. 1.
Fig. 1.
Health education on not using cervical collar after ACDF surgery
Univariate analysis
The duration of cervical collar use was classified into two categories: ≤4 weeks and > 4 weeks. Chi-square tests were used to compare the differences between groups. The results revealed that the surgeon’s education level, years of practice, and annual case volume of ACDF significantly affected the duration of cervical collar use. In the > 4 weeks group, 7.2% (5/69) of the surgeons with a master’s degree or lower recommended this duration, whereas 37% (10/27) of those with a doctorate degree had a statistically significant difference (χ²=10.902, p < 0.001); 100% (2/2) of the surgeons with ≤ 5 years of experience were in the ≤ 4 weeks group, 33.3% (2/6) of those with 6 ∼ 10 years of practice, 30% (3/10) with 11 ∼ 15 years, and 11.9% (8/67) with > 20 years recommended > 4 weeks of cervical collar use, with a statistically significant difference (χ²=12.565, p = 0.006). Surgeons who performed fewer than 50 ACDF surgeries annually accounted for 7.9% (5/63) of those in the > 4 weeks group, 23.5% (4/17) in the 50 ∼ 100 years surgery group, and 37.5% (6/16) in the > 100 years surgery group; these differences were statistically significant (χ²= 8.96, p = 0.007). The detailed results are provided in Table 2.
Table 2.
Descriptive statistics for cervical collar use duration and related factors
| Variable | Category | Number (n) | Collar use duration | χ²/Fisher | P Value | |
|---|---|---|---|---|---|---|
| ≤ 4 weeks (%) | > 4 weeks (%) | |||||
| Gender | Male | 95 | 81 (85.3) | 14 (14.7) | 5.457 | 0.156 |
| Female | 1 | 1 (100) | ||||
| Age | < 30 years | 1 | 1 (100) | 4.582 | 0.127 | |
| 30 ∼ 50 years | 51 | 42 (82.4) | 9 (17.6) | |||
| 51 ∼ 70 years | 44 | 39 (88.6) | 5 (11.4) | |||
| Education level | Master’s degree or below | 69 | 64 (92.8) | 5 (7.2) | 10.902 | < 0.001 |
| Doctorate | 27 | 17 (63) | 10 (37) | |||
| Title | Resident | 1 | 1 (100) | 6.974 | 0.056 | |
| Attending physician | 5 | 3 (60) | 2 (40) | |||
| Associate chief physician | 17 | 14(82.4) | 3(17.6) | |||
| Chief physician | 73 | 64 (87.7) | 9 (12.3) | |||
| Years of Practice | ≤ 5 years | 2 | 2 (100) | 12.565 | 0.006 | |
| 6 ∼ 10 years | 6 | 4 (66.7) | 2 (33.3) | |||
| 11 ∼ 15 years | 10 | 7 (70) | 3 (30) | |||
| 16 ∼ 20 years | 11 | 11 (100) | ||||
| > 20 years | 67 | 59 (88.1) | 8 (11.9) | |||
| Hospital Level | Tertiary grade-A hospitals | 84 | 69(82.1) | 15(17.9) | 1.654 | 0.59 |
| Other hospitals | 12 | 12(100) | ||||
| Years of ACDF Experience | ≤ 5 years | 23 | 18(78.3) | 5(21.7) | 3.224 | 0.541 |
| 6 ∼ 10 years | 22 | 20(90.9) | 2(9.1) | |||
| 11 ∼ 15 years | 22 | 20(90.9) | 2(9.1) | |||
| 16 ∼ 20 years | 11 | 8(72.7) | 3(27.3) | |||
| > 20 years | 18 | 15(83.3) | 3(16.7) | |||
| Annual ACDF Case Volume | < 50 surgeries | 63 | 58 (92.1) | 5 (7.9) | 9.438 | 0.009 |
| 50 ∼ 100 surgeries | 17 | 13 (76.5) | 4 (23.5) | |||
| > 100 surgeries | 16 | 10 (62.5) | 6 (37.5) | |||
| Graft Type | PEEK cage | 75 | 62 (82.7) | 13 (17.3) | 1.015 | 0.772 |
| Lliac crest | 20 | 18(90) | 2(10) | |||
| Other | 1 | 1(100) | ||||
Multivariate analysis
In the multivariate logistic regression analysis, the duration of cervical collar use was treated as the dependent variable, with the independent variables including education level, years of practice, and annual case volume of single-level ACDF surgeries. The results indicated that years of practice were an independent predictor of the duration of cervical collar use (OR = 0.572, 95% CI: 0.348 ∼ 0.939; P = 0.027). The detailed results are provided in Tables 3 and 4.
Table 3.
Variable coding explanation
| Variable | Coding |
|---|---|
| Cervical collar use duration | ≤ 4 weeks = 0, > 4 weeks = 1 |
| Education level | Master’s degree or below = 0, Doctorate = 1 |
| Years of Practice | ≤ 5 years = 0, 6 ∼ 10 years = 1, 11 ∼ 15 years = 2, 16 ∼ 20 years = 3, > 20 years = 4 |
| Annual ACDF Case Volume | < 50 surgeries = 0, 50 ∼ 100 surgeries = 1, > 100 surgeries = 2 |
Table 4.
Multivariate analysis of factors affecting cervical collar use duration
| Variable | B | SE | Wald χ² | P Value | OR (95%CI) |
|---|---|---|---|---|---|
| Education level | 1.296 | 0.77 | 2.833 | 0.092 | 3.656 (0.808 ∼ 16.54) |
| Years of Practice | -0.559 | 0.254 | 4.867 | 0.027 | 0.572 (0.348 ∼ 0.939) |
| Annual ACDF Case Volume | 0.544 | 0.442 | 1.509 | 0.219 | 1.722 (0.724 ∼ 4.099) |
Discussion
Our survey findings revealed significant differences in the duration of cervical collar use recommended by spine surgeons in Heilongjiang Province following single-level ACDF. The most commonly reported duration was 3 weeks, with a range from no use at all (2.08%) to 12 weeks (4.17%). This variation is consistent with previous studies that highlighted the lack of consensus on the optimal duration of cervical collar use post-ACDF. For example, Gwynedd et al. reported that Canadian surgeons typically recommend 1 ∼ 12 weeks of cervical collar use [25]. In contrast, Baweja et al. reported that 60.9% of surgeons do not recommend cervical collar use after ACDF, 31% recommend it, and 8% use it occasionally [26]. Our study revealed that shorter durations of cervical collar use may reflect the increasing use of anterior cervical plates, which provide enhanced cervical stability and reduce the need for prolonged external fixation [32]. However, compared with Baweja et al. [26], our study reported longer cervical collar use. One of the possible reasons for this phenomenon is that the spine surgeons in Heilongjiang Province have formulated a plan for the use of cervical collars after fully considering the unique local climatic factors. Heilongjiang province has a cold winter climate characterized by icy roads, limited outdoor activities, and insufficient sunlight, which can lead to vitamin D and calcium deficiencies, which can increase the risk of falls and prolong bone healing [33–35]. As a result, it may be necessary to wear a cervical collar for a longer period of time to provide additional protection for the cervical spine.
Our results suggest that the duration of cervical collar use after ACDF is influenced by several factors, including the surgeon’s education level, years of practice, and annual case volume of single-level ACDF surgeries. Notably, years of practice was an independent predictor of duration of cervical collar use (OR = 0.572, 95% CI: 0.348 ∼ 0.939; P = 0.027). This finding aligns with the study by Cabrera et al., which demonstrated that a surgeon’s years of practice influence decisions such as the use of wound drainage in lumbar fusion surgeries [36]. In our survey, surgeons with more than 20 years of clinical experience were more likely to recommend reducing cervical collar use to ≤ 4 weeks (88.1%). This suggests that more experienced surgeons may rely on clinical judgment to determine that prolonged cervical collar use is unnecessary, likely due to advances in surgical techniques and the stability provided by implants [37, 38]. However, there are few studies on the effect of a surgeon’s length of practice on the duration of cervical collar use. We believe that surgeons with less clinical experience tend to take a more conservative approach. Specifically, they may recommend extending the use of the cervical collar to limit neck movement, with the aim of ensuring stability at the surgical site. This cautious strategy may stem from their concern about potential complications.
The variation in the duration of cervical collar use highlights the need for standardized guidelines. Prolonged cervical collar use can lead to complications such as axial symptoms, pressure sores, and a reduced cervical range of motion [9, 20, 23]. Axial symptoms, in particular, significantly impact patients’ quality of life. A retrospective study by Yu et al. revealed that avoiding cervical collar use after ACDF reduced the incidence of axial symptoms and facilitated faster recovery of cervical motion [9]. Therefore, shortening the duration of cervical collar use could improve patient outcomes and facilitate earlier resumption of daily activities.
Our survey revealed that 54% of the surgeons believed that cervical collars could be avoided after ACDF, but only 2% of the surgeons did not prescribe collars postoperatively. This discrepancy between belief and practice warrants further investigation. This finding likely reflects surgeons’ concerns regarding patient safety and potential complications such as graft subsidence or nonfusion. However, evidence suggests that modern intervertebral fusion devices, such as PEEK cages, reduce the risk of graft subsidence and may reduce the need for prolonged cervical collar use [37]. PEEK cages were the most commonly used graft material in our study (78.13%), and studies such as that of Cho et al. have shown higher fusion rates with PEEK cages than with traditional iliac crest autografts (100% vs. 93.1%) [38], potentially reducing the need for cervical collar use post-surgery.
Our study also revealed a preference for soft cervical collars over hard collars (53% vs. 47%), which aligns with findings from other regions. Bible et al. reported that soft collars are more commonly used post-ACDF in the United States [27]. This may be because a soft collar can provide sufficient limitations and reduce the risk of collar-related complications compared to a hard collar. Miller et al. compared the difference in mean cervical spine range of motion between participants using a soft and hard collar brace during 15 activities of daily living (standing to sitting, reversing, tying shoes, etc.). The results showed that there was no statistically significant difference in cervical spine range of motion between soft and hard collars in most daily activities (13 out of 15). The authors conclude that a hard collar may not be necessary in many cases, as a soft collar also appears to be sufficient to limit cervical spine motion [39]. In a study comparing the incidence of prognostic adverse events with a hard collar in patients with cervical spine injury in the emergency department, patients with a soft collar had significantly lower pain scores and a lower rate of pain compared with those with a hard collar [40]. In addition, existing studies have shown that potential adverse reactions associated with the use of hard cervical collars include restricted breathing, dysphagia, muscle atrophy, and so on [21, 41]. Therefore, we believe that soft collars are more beneficial for patients following cervical spine surgery.
Innovation and limitations
This study is the first to investigate the duration of cervical collar use guided by domestic spinal surgeons for patients after ACDF surgery and its influencing factors.
Our findings provide a basis for designing future multicenter, prospective randomized controlled trials to establish evidence-based guidelines and a consensus for cervical collar use. Furthermore, the survey included content on patient health education for those not using cervical collars postsurgery, which has yet to be widely studied. As guidelines and consensuses develop, this aspect should be optimized.
However, our study has certain limitations. Firstly, as this is a cross-sectional survey, it is impossible to determine causal relationships. Longitudinal studies should be considered in further research. Secondly, the survey did not consider patient-specific factors, such as comorbidities (e.g., diabetes, osteoporosis) and lifestyle factors (e.g., smoking), which may influence decisions regarding cervical collar use and its duration [25]. Previous studies have shown that diabetes mellitus increases the risk of fractures, interferes with bone formation, and impairs fracture healing [42]; osteoporosis is a known risk factor for the subsidence of the transplanted bone [43]; and smoking prolongs the time of bone healing [44]. Patients with such conditions require an extended duration of cervical collar wear. Future studies should take these factors into consideration to gain a more comprehensive understanding of the use of cervical collars.
Conclusion
In conclusion, the results of our survey indicate that spine surgeons in Heilongjiang Province have varying suggestions regarding the duration of cervical collar wear after single-level ACDF. These findings suggest the necessity of formulating standardized guidelines and consensus on this issue, as well as improved postoperative health education to reduce complications associated with prolonged cervical collar use, such as axial symptoms, and to improve patients’ postoperative quality of life. Surgeons’ education level, years of practice, and annual case volume of single-level ACDF surgeries influence the duration of patients’ use of cervical collars. Among these factors, years of practice are an independent factor affecting cervical collar duration. Future research should focus on patient-specific factors and implants on cervical collar use practices.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Acknowledgements
Not applicable.
Abbreviations
- ACDF
Anterior cervical discectomy and fusion
Author contributions
JXX, WZ, and CL contributed to the research design. All the authors jointly contributed to the design of the questionnaire. KW, CGJ, and XLY contributed to the data collection and data analysis. CL and YTZ contributed to the manuscript. JXX, WZ, project administration, supervision. All the authors read and approved the final manuscript.
Funding
This study was funded by the Natural Science Foundation of Heilongjiang Province (grant number PL2024H075) and Nursing Scientific Research Project of the First Affiliated Hospital of Harbin Medical University (grant number 2025H01).
Data availability
The datasets generated during or analysed during the current study are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
The study was approved by the Ethics Committee of the First Affiliated Hospital of Harbin Medical University (No. 2024339).The ethical standards from the 1964 Helsinki declaration and its later amendments were upheld. Informed consent was obtained from all participants for this study.
Consent for publication
Not Applicable.
Conflict of interest
The authors declare that they have no conflicts of interest.
Clinical trial number
Not applicable.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Contributor Information
Wei Zhao, Email: zwxjx0517@126.com.
Jiaxing Xu, Email: zwxjx0602@126.com.
References
- 1.Tang L, Chen Y, Wang F, Liu Y, Song Z, Wang M, et al. Safety and efficacy of day anterior cervical discectomy and fusion procedure for degenerative cervical spondylosis: a retrospective analysis. BMC Musculoskelet Disord. 2024;25(1):223. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Lv Y, Tian W, Chen D, Liu Y, Wang L, Duan F. The prevalence and associated factors of symptomatic cervical spondylosis in Chinese adults: a community-based cross-sectional study. BMC Musculoskelet Disord. 2018;19(1):325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Badhiwala JH, Ahuja CS, Akbar MA, Witiw CD, Nassiri F, Furlan JC, et al. Degenerative cervical myelopathy - update and future directions. Nat Rev Neurol. 2020;16(2):108–24. [DOI] [PubMed] [Google Scholar]
- 4.Kamalapathy PN, Puvanesarajah V, Sequeria S, Bell J, Hassanzadeh H. Safety profile of outpatient vs inpatient ACDF: an analysis of 33,807 outpatient ACDFs. Clin Neurol Neurosurg. 2021;207:106743. [DOI] [PubMed] [Google Scholar]
- 5.Wang C, Tian F, Zhou Y, He W, Cai Z. The incidence of cervical spondylosis decreases with aging in the elderly, and increases with aging in the young and adult population: a hospital-based clinical analysis. Clin Interv Aging. 2016;11:47–53. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Takagi I, Eliyas JK, Stadlan N. Cervical spondylosis: an update on pathophysiology, clinical manifestation, and management strategies. Dis Mon. 2011;57(10):583–91. [DOI] [PubMed] [Google Scholar]
- 7.Global regional. National incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the global burden of disease study 2013. Lancet. 2015;386(9995):743–800. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Somay H, Bolukbasi BA, Karaarslan N, Berkman MZ. An assessment of the effectiveness of surgical treatment methods used for cervical spondylosis. Turk Neurosurg. 2022;32(2):261–70. [DOI] [PubMed] [Google Scholar]
- 9.Yu Q, Ren Y, Wang Z, Xu G, Ma Y, Ye F. The effect of a cervical Brace on postoperative axial symptoms following Single-level anterior cervical discectomy and fusion. Clin Spine Surg. 2024. [DOI] [PubMed]
- 10.Lambrechts MJ, Issa TZ, Toci GR, D’Antonio ND, Karamian BA, Tecce E, et al. Soft cervical orthosis use does not improve fusion rates after One-Level and Two-Level anterior cervical discectomy and fusion. World Neurosurg. 2022;167:e1461–7. [DOI] [PubMed] [Google Scholar]
- 11.Saifi C, Fein AW, Cazzulino A, Lehman RA, Phillips FM, An HS, et al. Trends in resource utilization and rate of cervical disc arthroplasty and anterior cervical discectomy and fusion throughout the united States from 2006 to 2013. Spine J. 2018;18(6):1022–9. [DOI] [PubMed] [Google Scholar]
- 12.Hajeeyeh M, Wilartratsami S, Phisalprapa P, Piyapromdee U, Sornsa-Ard T, Kositamongkol C, et al. Cost-utility analysis of anterior cervical discectomy and fusion for cervical spondylosis patients comparing polyetheretherketone versus tricortical Iliac crest bone graft. Clin Spine Surg. 2023;36(8):E353–61. [DOI] [PubMed] [Google Scholar]
- 13.Scerrati A, Germano A, Montano N, Visani J, Cacciola F, Raffa G, et al. Factors affecting functional outcome after anterior cervical discectomy and fusion: A multicenter study. J Craniovertebr Junction Spine. 2021;12(2):144–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Brannigan JFM, Mowforth OD, Francis JJ, Budu A, Laing RJ, Davies BM. Hard collar immobilisation following elective surgery on the cervical spine: a cross-sectional survey of UK spinal surgeons. Br J Neurosurg. 2022;36(5):627–32. [DOI] [PubMed] [Google Scholar]
- 15.Ricciardi L, Scerrati A, Olivi A, Sturiale CL, De Bonis P, Montano N. The role of cervical collar in functional restoration and fusion after anterior cervical discectomy and fusion without plating on single or double levels: a systematic review and meta-analysis. Eur Spine J. 2020;29(5):955–60. [DOI] [PubMed] [Google Scholar]
- 16.Camara R, Ajayi OO, Asgarzadie F. Are external cervical orthoses necessary after anterior cervical discectomy and fusion: A review of the literature. Cureus. 2016;8(7):e688. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.McKeon JF, Alvarez PM, Castaneda DM, Emili U, Kirven J, Belmonte AD et al. Cervical collar use following cervical spine surgery: A systematic review. JBJS Rev. 2024;12(9). [DOI] [PubMed]
- 18.Caplan IF, Sinha S, Osiemo B, McClintock SD, Schuster JM, Smith H, et al. The utility of cervical spine bracing as a postoperative adjunct to multilevel anterior cervical spine surgery. Int J Spine Surg. 2020;14(2):151–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Miller CP, Bible JE, Jegede KA, Whang PG, Grauer JN. The effect of rigid cervical collar height on full, active, and functional range of motion during fifteen activities of daily living. Spine (Phila Pa 1976). 2010;35(26):E1546–52. [DOI] [PubMed] [Google Scholar]
- 20.Shin HK, Park D, Jeon SR, Roh SW, Park JH. Is it necessary to use a cervical Brace after single- or double-level ACDF? Med (Baltim). 2024;103(27):e38816. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Behnammoghadam M, Alimohammadi N, Riazi A, Eghbali-Babadi M, Rezvani M. Incidence of cervical collar-related pressure injury in patients with head and neck trauma: A scoping review study. J Educ Health Promot. 2023;12:252. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Oyekan AA, LeVasseur CM, Chen SR, Padmanabhan A, Makowicz N, Donaldson WF, et al. The effects of cervical orthoses on head and intervertebral range of motion. Spine (Phila Pa 1976). 2023;48(22):1561–7. [DOI] [PubMed] [Google Scholar]
- 23.Jarvis S, Sater A, Gordon J, Nguyen A, Banton K, Bar-Or D. Cervical collars and dysphagia among geriatric TBIs and cervical spine injuries: A retrospective cohort study. J Healthc Qual. 2023;45(3):160–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 24.Zhang T, Gao G, Li Y, Gao F, Yang W, Wang Y, et al. Comparison of outcomes after anterior cervical discectomy and fusion with and without a cervical collar: a systematic review and meta-analysis. J Orthop Surg Res. 2024;19(1):172. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Pickett GE, Van Soelen J, Duggal N. Controversies in cervical discectomy and fusion: practice patterns among Canadian surgeons. Can J Neurol Sci. 2004;31(4):478–83. [DOI] [PubMed] [Google Scholar]
- 26.Baweja RK, Bennardo M, Farrokhyar F, Martyniuk A, Reddy K. A Canadian perspective on anterior cervical discectomies: practice patterns and preferences. J Spine Surg. 2018;4(1):72–8. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Bible JE, Biswas D, Whang PG, Simpson AK, Rechtine GR, Grauer JN. Postoperative bracing after spine surgery for degenerative conditions: a questionnaire study. Spine J. 2009;9(4):309–16. [DOI] [PubMed] [Google Scholar]
- 28.Metayer T, Ferracci FX. Cervical collar after one level instrumented anterior cervical discectomy: an unscientific myth. Neurochirurgie. 2022;68(2):247–8. [DOI] [PubMed] [Google Scholar]
- 29.Scerrati A, Visani J, Norri N, Cavallo M, Giganti M, De Bonis P. Effect of external cervical orthoses on clinical and radiological outcome of patients undergoing anterior cervical discectomy and fusion. Acta Neurochir (Wien). 2019;161(10):2195–200. [DOI] [PubMed] [Google Scholar]
- 30.Ma Y, Deng SC, Liu JK, Hao YH, Li JJ, Lü GY. [Anterior cervical discectomy and fusion in the treatment of hangman’s fracture]. Zhonghua Yi Xue Za Zhi. 2010;90(35):2451–4. [PubMed] [Google Scholar]
- 31.Kendall M. Multivariate analysis. London: Charles Griffin & Co.; 1975. [Google Scholar]
- 32.Böhler J, Gaudernak T. Anterior plate stabilization for fracture-dislocations of the lower cervical spine. J Trauma. 1980;20(3):203–5. [DOI] [PubMed] [Google Scholar]
- 33.Gorter EA, Krijnen P, Schipper IB. Vitamin D status and adult fracture healing. J Clin Orthop Trauma. 2017;8(1):34–7. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep). 2007(158):1–235. [PMC free article] [PubMed]
- 35.Holick MF. Sunlight and vitamin D for bone health and prevention of autoimmune diseases, cancers, and cardiovascular disease. Am J Clin Nutr. 2004;80(6 Suppl):s1678–88. [DOI] [PubMed] [Google Scholar]
- 36.Cabrera JP, Gary MF, Muthu S, Yoon ST, Kim HJ, Cho SK et al. Surgeon preferences worldwide in wound drain utilization in open lumbar fusion surgery for degenerative pathologies. Global Spine J. 2023:21925682231210184. [DOI] [PMC free article] [PubMed]
- 37.Carpenter RD, Klosterhoff BS, Torstrick FB, Foley KT, Burkus JK, Lee CSD, et al. Effect of porous orthopaedic implant material and structure on load sharing with simulated bone ingrowth: A finite element analysis comparing titanium and PEEK. J Mech Behav Biomed Mater. 2018;80:68–76. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 38.Cho DY, Liau WR, Lee WY, Liu JT, Chiu CL, Sheu PC. Preliminary experience using a polyetheretherketone (PEEK) cage in the treatment of cervical disc disease. Neurosurgery. 2002;51(6):1343-49; discussion 9–50. [PubMed]
- 39.Miller CP, Bible JE, Jegede KA, Whang PG, Grauer JN. Soft and rigid collars provide similar restriction in cervical range of motion during fifteen activities of daily living. Spine (Phila Pa 1976). 2010;35(13):1271–8. [DOI] [PubMed] [Google Scholar]
- 40.Baker R, Klim S, Poonian J, Ritchie P, Ng S, Kelly AM. SOFTLY: comparison of outcomes of rigid versus soft collar during emergency department investigation for potential cervical spine injury in low-risk blunt trauma patients - A pilot study. Emerg Med Australas. 2023;35(4):652–6. [DOI] [PubMed] [Google Scholar]
- 41.Freeman J, Nikjou D, Maloney J, Covington S, Pew S, Wie C, et al. The role of orthoses in chronic axial spinal conditions. Curr Pain Headache Rep. 2024;28(6):501–6. [DOI] [PubMed] [Google Scholar]
- 42.Jiao H, Xiao E, Graves DT. Diabetes and its effect on bone and fracture healing. Curr Osteoporos Rep. 2015;13(5):327–35. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 43.Opsenak R, Hanko M, Snopko P, Varga K, Kolarovszki B. Subsidence of anchored cage after anterior cervical discectomy. Bratisl Lek Listy. 2019;120(5):356–61. [DOI] [PubMed] [Google Scholar]
- 44.Sadeghifar A, Sheibani M, Joukar S, Dabiri S, Alavi S, Azari O, et al. The effect of waterpipe tobacco smoking on bone healing following femoral fractures in male rats. Front Surg. 2021;8:722446. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Supplementary Materials
Data Availability Statement
The datasets generated during or analysed during the current study are available from the corresponding author upon reasonable request.