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CERVICAL SPINE
From the Department of Orthopaedic Surgery at Rush University Medical Center in Chicago, Illinois, and 2MedStar Health Orthopedics at MedStar Georgetown University Hospital in Washington, D.C. 1
DME in Cervical Spine Surgery What Does the Evidence Say? Mattin Moazzam, BS
1
Aditya Mazmudar, MD, MBA2
Arash Sayari, MD1
Durable medical equipment (DME) for the cer vical spine prescribed postoperatively must be select ive, pat ient-specific, and grounded in clinical e v idenc e. H i stor ic a l l y, t he distribution of postoperative dev ices has been g uided by institutional convention rather than high-level literature. As spine surgery transitions deeper into value-based care models, postoperative modalities must face the same rigorous scrutiny to optimize clinical outcomes while minimizing unnecessary financial and compliance burdens for the patient.
Cervical Collars: Purpose and Types Cervical collars are often prescribed to limit postoperative motion, provide comfort, and offer patients a sense of reassurance during early recovery. It is important to recognize, however, that collars do not replace internal fixation—they supplement it. The degree of immobilization varies substantially by collar type: soft collars, rigid collars, and cervicothoracic orthoses.1–3 Soft collars provide minimal motion restriction, demonstrating poor immobilization in all planes. They function primarily as a comfort measure and proprioceptive reminder to limit neck
Summer 2026 Vertebral Columns
movement.1 Rigid collars such as the Aspen and Miami J provide moderate restriction of flexion and extension but only poor restriction of lateral bending and rotation. The NecLoc demonstrated t he greatest overall motion restriction among rigid cervical orthoses.1–3 Cervicothoracic orthoses such as the Sternal Occipital Mandibular Immobilizer brace extend fixation to the thorax, providing moderate to substantial restriction of f lexion/extension and rotation, though restriction of lateral bending is comparatively less effective.1,4
Evidence-Based Use of Cervical Collars The routine use of cervical collars after 1- to 2-level anterior cervical discectomy and fusion (ACDF) is not strongly supported by the available evidence. A systematic review of 25 studies found that while cervical collar use improved short-term patient-reported outcomes and early pain control, the majority of the data showed no significant difference in long-term fusion rates between braced and unbraced patients. 5 This finding was corroborated by a comparative cohort study of 83 patients undergoing 1- or 2-level ACDF, which found no statistically significant difference in any clinical measure, fusion rate, subsidence, or complication rate between braced and unbraced groups.6 Despite this lack of clinical evidence, surgeon surveys
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