Are Rigid Cervical Collars Necessary for Open-door Laminoplasty and Titanium Arch Plates for Cervical Myelopathy?
Are Rigid Cervical Collars Necessary for Open-door Laminoplasty and Titanium Arch Plates for Cervical Myelopathy?
This is a randomized controlled trial to assess the use of rigid neck collar postoperatively.
 It consists of patients with cervical myelopathy undergoing open-door laminoplasty with
 titanium arch plates. Patients are divided into two groups: one group are not using rigid
 neck collar whereas the second group of patients wear rigid neck collar for three weeks
 postoperatively. Both groups of patients will then be assessed at fixed intervals. Clinical
 assessments include the cervical spine range of motion, any axial neck pain and also a full
 neurological examination. Radiographs will be used to assess for any complications. Cervical
 spine alignment and relevant questionnaires will be done and recorded. These results will
 help to conclude whether we can avoid the use of rigid cervical collars postoperatively, in
 view of the associated problems arising from restricted neck movement.
Current management protocols regarding cervical laminoplasty is to provide early
 immobilization with rigid cervical neck collars to avoid implant failure, loss of correction
 and recurrence of neurological deficit. However, there is no strong evidence supporting the
 need for neck collars in laminoplasty especially since modern plating fixation methods are
 already very rigid. Cervical neck collars should also not be used haphazardly due to possible
 complications and cost implications. Cervical range of motion has been shown to reduce with
 rigid cervical collars. Decreased voluntary eye movement and postural stability has also been
 illustrated. Longer duration of neck collar use may even lead to postoperative axial neck
 pain. Neck collars has also been linked to complications such as pressure ulcers, nerve
 palsy, skin reactions, dysphagia and respiratory problems. The costs of collar manufacturing
 and maintenance is not small and must also be taken into consideration. With stronger
 fixation devices like plates, the above complications can be avoided. Most clinicians still
 use neck collars for protection mainly due to historical reasons. However this is not an
 evidence-based approach. By eliminating the need for neck collars, patients are allowed
 earlier mobilization, less neck stiffness and axial neck pain while reducing its cost. Hence
 this study is important to provide a basis for changing clinical practice. The study is a
 prospective randomized controlled trial. Patients are consecutively and randomly divided into
 two groups . One group of patients will receive no cervical collar postoperatively and a
 second group will receive rigid neck collar for 3 weeks postoperatively. Operative techniques
 will be standardized. All assessments are performed 3 and 6 weeks, and 3, 6, 12 and 24 months
 postoperatively. The subjects were analysed in terms of clinical and functional outcomes
 through radiographic measurements, clinical assessment and questionnaires.
Inclusion Criteria:

 -  Patients attending either Queen Mary Hospital or Duchess of Kent Children's Hospital,
 who are over 18 years of age, and present with clinical and radiological signs
 compatible with cervical myelopathy undergoing laminoplasty. Patients must be literate
 and able to comprehend the study to be enrolled.

 Exclusion Criteria:

 -  All patients with previous cervical spine surgery, congenital deformities, spine
 infection or inflammation, tumour, fusion surgery, non-Chinese, undergoing workman's
 compensation and unable or refuse to follow the standardized rehabilitation protocol.