Postoperative bracing following anterior cervical discectomy and fusion (ACDF) is a common practice with unclear clinical benefit. We hypothesized that patients receiving postoperative bracing following ACDF would demonstrate similar short- and long-term outcomes compared to patients not receiving bracing.

This was a multi-institutional, retrospective cohort study of adult patients undergoing primary, single- and multi-level ACDF conducted on an electronic medical record database. The study cohort received rigid postoperative cervical spine bracing and the control group did not. Exclusion criteria were prior cervical spine surgery and neoplastic, traumatic, inflammatory, or infectious bone conditions. Comparisons were conducted with t-tests.

Propensity matching resulted in 1,405 patients in the single-level and 1,926 patients in the multi-level cohorts receiving rigid postoperative bracing. At thirty-days, most medical complications occurred in fewer than 1% of patients and did not differ between study groups. At ninety-days following multi-level ACDF, patients treated with cervical spine bracing demonstrated lower rates of opioid utilization compared to controls (76.8% vs 81.2%; RR: 0.9, 95% CI: 0.9–1.0; P < 0.001). At two- and five-years, patients in the single- and multi-level ACDF cohorts demonstrated similar rates of long-term complications based on bracing status. Rates of pseudoarthrosis, adjacent segment disease, and cervical spine reoperation were similar between patients in both cohorts following single- and multi-level ACDF (P > 0.05).

Patients receiving rigid postoperative cervical spine bracing demonstrated similar rates of short- and long-term complications following ACDF including similar rates of thirty-day complications and cervical spine reoperation at five years.