Cervical Spondylosis Symptomatic Neurological Compression Clinical Trial
Official title:
Collar Immobilization Following a Posterior Cervical Laminectomy and Fusion: A Randomized Controlled Trial
Cervical collars are commonly used to provide external immobilization after elective
Posterior Cervical Laminectomy and Interbody Fusion (PCLIF). The rationale for collar use is
the perception and assumption that it can prevent early instrumentation failure and promote
successful spinal fusion. However, there are a number of potential complications associated
with cervical collars such as skin breakdown, ulceration, neck pain, impedance upon
activities of daily living, and impaired swallowing. Considering these conflicting factors,
there is wide disagreement among spinal surgeons about the utility, benefits, and necessity
of collar use following elective PCLIF.
Hypothesis: Wearing a cervical collar for 12 weeks after posterior cervical laminectomy and
instrumented fusion will not demonstrate substantial benefits as measured by the incidence
of instrumentation failure, rate of nonunion, or clinical outcome measures.
Specific Aim I: To compare the outcomes of surgery in patients who will wear a cervical
collar for 12 weeks following surgery versus those who will have the collar removed prior to
discharge after surgery.
Following the informed consent process, subjects will fill out a baseline questionnaire
consisting of demographic information, visual analog scale (VAS) pain scores for neck and
arm pain, and the Neck Disability Index Questionnaire (NDI).
Following surgery, the surgeon will fill out an operative data collection sheet to record
information such as: levels fused, type of instrumentation, pre- and post-operative sagittal
alignment, and intra-operative complications (if applicable). Subjects will be randomized
into the "collar" or "no collar" group immediately following surgery, using a computer
generated randomization scheme, so as not to influence the surgeon's operative technique. If
the patient is randomized to the "no collar" group, he or she will actually have a hard
cervical collar placed in the operating room after surgery. This will remain in place for 1
to 2 days and be discontinued prior to discharge. If the patient is randomized to the
"collar" group, he or she will have the hard cervical collar placed after surgery. The
collar will be removed/exchanged for bathing, grooming, and dressing changes only. It will
remain in place for 12 weeks.
The patient will undergo usual and customary clinical and radiographic follow-up. This
includes physical examination and cervical radiographs taken at 2 weeks, 12 weeks, 6 month,
and 1 year. VAS and Neck Disability Index scores will be obtained at the 2 week, 12 week, 6
month, and 1 year follow-up visits. Radiographs will be assessed by a two independent
radiologists for instrumentation failure (defined as any of the following: screw loosening,
screw breakage, rod breakage, screw dislodgement) and fusion status. Solid fusion will be
defined as bridging trabecular bone between or along the lateral masses/facet joints of the
operated segments as assessed on a lateral cervical radiograph. In addition, the overall
sagittal alignment of the spine will be measured. For the primary outcome of the study,
final follow-up at 1 year would be considered satisfactory to determine differences in
pseudarthrosis and instrumentation failure.
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Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver), Primary Purpose: Treatment