Clavicle pain and reduction of incisional and fascial pain after posterior cervical surgery

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>Incisional pain after posterior cervical spine surgery can be severe and very unpleasant to the patient. Ongoing incisional pain is one of the key disadvantages of posterior over anterior surgical approaches to the cervical spine. It prolongs hospital stays and delays return to work. In this study, the hypothesized that incisional pain in the immediate postoperative period is caused partially by tension on the skin as well as on the deep cervical fascia and the fascia overlying the trapezius, which are usually sewn together during closure. Reduction of this tension through retraction of the shoulders should therefore reduce pain as well as the amount of pain medication used in the early postoperative period.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>In this prospective randomized controlled study, 30 patients who had undergone posterior cervical spine surgery were randomized into 2 groups who either wore or did not wear a clavicle brace to retract the shoulders. Patients in the brace group began wearing the brace on postoperative day (POD) 4 and wore it continuously throughout the 30-day study period. Outcome was assessed by two measures: 1) the daily level of self reported pain according to the visual analog scale (VAS) and 2) the number of pain pills taken during the 30-day postoperative period.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Wearing a clavicle brace in the immediate postoperative period significantly reduced incisional pain and the amount of pain medication that patients took. Beginning on POD 4 and continuing until day POD 13, the mean daily VAS score for pain was significantly lower in the brace group than in the control group. Furthermore, patients who wore the clavicle brace took less pain medication from POD 4 to POD 12. At this point the difference lost significance until the end of the study period. Four patients were randomized but did not tolerate wearing the brace.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Patients who tolerated wearing the clavicle brace after posterior cervical spine surgery had reduced pain and used less pain medication.</jats:p></jats:sec>

The Utility of Postoperative Bracing on Radiographic and Clinical Outcomes Following Cervical Spine Surgery: A Systematic Review

“…Lastly, one study discussed the use of clavicle bracing after posterior cervical or cervicothoracic decompressions and/or decompressions with fusions. 11 This study suggested that clavicle bracing may reduce acute postoperative pain and medication requirements, but the impact of cervical bracing was not assessed. This study did not assess fusion rates.…”

“…Duetzmann et al 11 looked at degenerative conditions of the cervical spine that required posterior cervical single or multi-level decompressions, with or without fusions, as well as posterior cervicothoracic decompressions and fusions. A total of 30 patients were included in the study; 15 patients, whose average age was 55 years, were not placed in clavicle brace in the postoperative period, and 15 patients, whose average age was 57 years, were braced postoperatively with a clavicle brace for 30 days.…”

“…Of relevance, different forms/variations of cervical spine braces exist and can have different goals or benefits. For example, this review included a study by Duetzmann et al 11 , who assessed the effectiveness of the clavicular brace following posterior cervical fusions and noted that patients reported statistically significant reduction in pain during the early post-operative period. The authors attribute this to the possible biomechanical advantages the brace provides as it reduces fascial pain brought about by the nature of the operation.…”

“…During the procedure, the surgeon must pass through 2 different layers of fascia which are later sewn back together. 11 The tension which is generated can cause pain. Hence, the clavicular brace works by reducing this tension, which effectively reduces pain.…”

Coverage of complex tissue defects following open cervicothoracic spine surgery with a lower trapezius island myocutaneous flap—an interdisciplinary approach

“…When operating between the cervical and upper thoracic spine, these predispositions may act in concert with the unique anatomy of the cervicothoracic spine by further increasing the risk for wound dehiscence. Surgical wounds over the cervicothoracic spine are more susceptible to mechanical stress such as pressure and tension around the wound boarders, but also on the fascia due to high tensile and traction forces of the trapezius muscle [ 15 ]. Also, postoperative paraspinal muscle atrophy around the cervicothoracic junction will often lead to relatively more prominent spinous processes and implants compromising already poor skin conditions, especially in elderly patients.…”