Physical Therapy in Pittsburgh for Upper Back and Neck
Q: My mother just had neck surgery to fuse three of her cervical vertebrae. She's moving very stiffly and can hardly function. We keep asking the doctor if she should be in a brace but the answer is always it's not necessary. Could she wear a soft collar for a few days to help give her neck a rest?
A: The debate about neck collars has been going on for decades. Some surgeons never have their patients use them -- even to stabilize the neck after a fusion procedure. Others use them to provide support and security for the patient but don't consider them really necessary. And when asked in a survey at least half of the surgeons fell somewhere in between those two opinions.
The debate continues beyond just whether or not to use collars. The next question is then: soft or rigid? Studies have clearly shown that soft collars don't restrict motion at the end ranges. That means if the person really wants to turn the head all the way to one side or the other (or fully flex or extend the neck), the collar doesn't prevent it. Tests show that rigid collars don't fully restrict motion either.
In fact, many patients still have up to half their normal motion even when inside a rigid neck brace. And given the fact that rigid neck collars can be hot, cause skin rashes and sores, and restrict swallowing and breathing, they can be difficult to get used to. If they don't really do any more than a soft collar, why bother using them?
A recent study from Yale University School of Medicine showed that bracing after neck surgery just isn't needed. Not only are many neck fusions held together internally with hardware like metal plates and screws but people seem able to regulate their own motion.
Your surgeon is quite right that a collar isn't necessary. Sometimes the added support provides the psychologic security needed to relax and begin moving again. At that point, a soft collar on a temporary basis will probably provide all of the extra support and proprioceptive input needed for daily tasks.
Reference: Christopher P. Miller, BA, et al. Soft and Rigid Collars Provide Similar Restriction in Cervical Range of Motion During Fifteen Activities of Daily Living. In Spine. June 1, 2010. Vol. 35. No. 13. Pp. 1271-1278.
