Jeffrey R. Carlson, MD
When I discuss cervical spine (neck) fusion surgery with a patient, one of the first questions they ask is “Will I have to wear a collar?” I’m not exactly sure why the neck brace engenders so many strong feelings among patients, most of whom have never tried one on, much less worn one for any length of time. Maybe we associate all cervical collars with the tacky courtroom dramas on TV in the 70s and 80s, where the plaintiff was rear-ended in an automobile accident and looking to collect big bucks from the poor sap that hit them. It could be that some patients have claustrophobia and can’t stand having anything around their neck. Maybe it is just because they look like they would be uncomfortable, like some modernized version of a medieval torture device. Whatever the reason for the dislike, let me explain the rationale for their use after cervical spine surgery and disprove some myths about them.
Myth 1: I have to wear a collar after surgery; if I don’t, the bone graft and all the screws and plates will come “undone” and I will have to have surgery again to fix it.
Most cervical fusion surgeries are done today are done on an outpatient basis because of the technological advances in instrumentation and technique. During a fusion, the disc is almost completely removed, a bone graft or device is used to replace the disc material and the two bones next to the removed disc are secured by plates and screws. Often a “cage” or interbody device will keep the appropriate amount of space between the spinal bones. The cages are comprised of inert materials and can be filled with bone grafts. These graft helps build a bridge between the two vertebrae and eventually the bones will grow and fuse together.
As result, the fusion surgery is pretty strong and stable. There really isn’t a huge danger of damaging the surgical work unless the head is moved an undue amount after surgery. For surgeries done anteriorly (front of the neck) this really isn’t an issue. For posterior fusions, very active patients who move their heads a lot could loosen the screws, but this doesn’t often happen.
Myth 2: My surgery will not heal and the bone will not fuse unless I keep my neck absolutely still. That’s why I have to wear a cervical collar.
For most patients, their bones will fuse well after surgery, with or without movement of the neck. Non-fusion or non-union is usually caused by other contributing factors, like having diabetes, alcoholism or smoking, before and after surgery. Bones grow, heal and repair themselves normally all throughout our lives, in a complex process called osteogenesis. Patients who are at risk for non-union will be identified and measures will be taken to help their bones fuse after surgery, like using a bone growth stimulator. The cervical neck collar does not assist the bones in fusing.
Myth 3: The cervical collar will keep my neck absolutely still and I will have no neck movement.
Even the best-fitted cervical collars allow some movement of the head and neck. Collars that are too tight are actually unsafe and can compress vital blood pathways and nerves. Our goal in employing a cervical collar is to provide a relatively comfortable, secure and protective device during the first week to ten days post-surgery. I want my patients to feel secure knowing that they likely will not be able to injure themselves or “undo” their surgery when they wear their collar. I want their surgical incision to be protected as it heals and the collar provides a safeguard against children, pets, amorous spouses, etc. Maybe most of all, the collar also provides my patients with a reminder that they have had a major surgery and that they need to rest and recover for the best outcome.
Myth 4: I have to wear my collar 24 hours a day, 7 days a week.
Cervical fusion patients typically feel tired and sleep a lot in the first few days after surgery. This is due to the after-effects of anesthesia, pain medications and the overall stress of having a major surgery. The good news is that patients do not have to wear their collars while sleeping, although some patients will find it more comfortable to use the collar to keep the surgical site still while trying to get some rest. They do not have to wear their collar in the shower or bath. I ask my patients to wear their collars while up throughout the day, walking or during any other activity. Any time you need to take a break from the collar, do so. The collar is intended to provide comfort for the surgical area, but if it is too uncomfortable take it off when you are in complete control of your neck.