title: Clavicle pain and reduction of incisional and fascial pain after posterior cervical surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Patients who tolerated wearing the clavicle brace after posterior cervical spine surgery had reduced pain and used less pain medication.
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and.|Department of Neurosurgery, Goethe University, Frankfurt, Germany.
authors: Stephan
authors: S
authors: Duetzmann
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and.
authors: Tyler
authors: T
authors: Cole
authors: Department of Neurosurgery, Goethe University, Frankfurt, Germany.
authors: Christian
authors: C
authors: Senft
authors: Department of Neurosurgery, Goethe University, Frankfurt, Germany.
authors: Volker
authors: V
authors: Seifert
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and.
authors: John Kevin
authors: JK
authors: Ratliff
authors: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California; and.
authors: Jon
authors: J
authors: Park
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001915:Braces; D002574:Cervical Vertebrae; D002968:Clavicle; D005205:Fascia; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D011446:Prospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D013529:Surgical Wound Dehiscence / Q000209:etiology / Q000517:prevention & control; D013904:Thoracic Vertebrae; D016896:Treatment Outcome
keywords: PCA = patient-controlled anesthesia pump; POD = postoperative day; VAS = visual analog scale; clavicle brace; fascial pain; incisional pain; posterior cervical spine surgery