Comparative Study Between the Results of Anterior Cervical Discectomy and Fusion Using Philadelphia or Soft Collar Postoperatively

Abstract

Background data: Anterior cervical discectomy and fusion (ACDF) is a well-known operative technique for treating cervical disc diseases causing myelopathy and/or radiculopathy. Postoperative immobilization with a rigid cervical brace is widely followed after ACDF using a standalone cage and soft braces frequently. Some authors have recommended using postoperative cervical braces while others do not, and among surgeons who agree with postoperative collar usage, the type of cervical orthoses and the duration of use are also issues of debate. Purpose: This study aims to compare between results of ACDF by using the Philadelphia collar and soft collar postoperatively. Study design: A prospective study. Patient and Methods: This study included 60 patients with ACDF: 28 used Philadelphia collar (group I) and 32 used soft collar (group II). Cases with single-level ACDF to 4 levels are included, and revision and deformity cases are excluded. For one year, both groups were followed up regarding fusion rate, subsidence, cage migration, neck disability index (NDI), and visual analog score (VAS) of the neck and arm pain. Results: Neck and arm pains using VAS scores preoperatively and 3 months, 6 months, and 12 months postoperatively also showed no significant difference between both groups. Subsidence was noticed among two patients (7.1%) in group I and one patient in group II (3.1%). No significant differences in fusion rates were found between both groups. After a 12-month follow-up in more than two-level procedures, the NDI score among group II was significantly lower (p = 0.045). Linear regression analysis revealed that preoperative NDI, age, BMI, and operation level were the predictors of postoperative NDI, excluding the presence of diabetes mellitus (DM) and brace type. Conclusion: Cervical brace after ACDF either by Philadelphia or soft collar does not affect the fusion rate, cage subsidence, or outcomes of the neck and arm pain. (2021ESJ255)