Objective: Practice patterns for using cervical collars vary widely following cervical spine surgery. We surveyed spine surgeons regarding their postoperative usage of cervical collars, postulating that their use would be controversial and both surgeon and patient-pathology dependent.

Methods: An online survey was created and distributed to neurosurgical and orthopedic residents, spine fellows, and attending surgeons. Demographic characteristics of the respondents were obtained. The anonymous survey consisted of 19 questions addressing indications for use of a cervical collar, its rationale, and duration of use. Responses were evaluated with percent agreement and inter-rater reliability as measured by Gwet's AC1. For individual questions, the proportion of positive answers was compared to the proportion expected by chance alone.

Results: Three hundred forty participants from 39 states in the U.S. and 41 countries responded to the survey. The percent agreement across all questions was greater than the 50% expected by chance alone (58% 56.5%, 58.5%) and there was modest inter-rater reliability (Gwet's AC=0.23, p<0.001). Providers' decisions to use a collar varied significantly by pathology (p<0.0001), procedure performed (p<0.0001), duration of use (p<0.0001), and rationale for use (p<0.0001). The presentation for which there was most agreement to use collars was trauma (81%), the greatest agreement not to use collars was infection (19%), and the lowest rate of agreement was neoplasm (48% 42.3%, 53.0%). Collars were utilized most often following multilevel corpectomy (2+ levels, 74% 69.1%, 78.5%), least often following disc arthroplasty (13% 9.6%, 16.9%), and the lowest rate of agreement was seen for 1-2 level posterior cervical fusion (44% 38.5%, 49.1%). Providers were more likely to use a collar for posterior approach surgery (OR=3.94 2.48, 6.26, p<0.0001). The most common rationales for using a collar were to limit the patient's activity (56%), support arthrodesis (47%), and reduce pain (41%). A total of 88% of providers have observed complications from cervical collar use in their practice.

Conclusions: The use of cervical collars is controversial, and providers' practices vary significantly in terms of pathologies, procedures, rationales, and duration. These findings underscore the need for evidence-based recommendations to guide clinical practice.