Houston Methodist Study Suggests Cervical Collars Do More Harm Than Good After Neck Surgery

The use of cervical collars following spine surgery may be unnecessary and potentially harmful, according to a Houston Methodist Hospital study that challenges decades of conventional wisdom about routine bracing of patients.

The study, published in Clinical Spine Surgery and presented at the Cervical Spine Research Society annual meeting last year, found there was no statistically significant difference in fixation failure or surgical complications between braced and unbraced patients. In fact, three of the four patients who experienced postoperative failure were wearing a collar, suggesting the device not only did not prevent complications, it may even have contributed to them.

"The hardware we implant in the spine is designed to act as an internal brace," said Dr. Mark Prasarn, an orthopedic surgeon at Houston Methodist and the study's primary investigator. "External collars don't improve healing outcomes, and what we've seen is that they can actually interfere with rehabilitation, cause swallowing problems, and even lead to pressure ulcers requiring plastic surgery."

Dr. Prasarn said the research was inspired by his unique perspective following patients through surgery, surgical recovery and daily rehab earlier in his career. "Seeing patients struggle with these collars day after day made it very clear we needed to study this more formally," he said.

The retrospective study analyzed outcomes for more than 200 patients who underwent surgery for traumatic cervical spine injuries. Roughly two-thirds of patients in the study were placed in rigid cervical collars after surgery, while the rest were not.

Neck braces are still commonly prescribed after cervical spine surgery, despite emerging evidence from Houston Methodist and other institutions suggesting minimal, if any, benefit. Dr. Prasarn's study adds weight to a growing movement in orthopedics and physical medicine to reevaluate outdated protocols that may be hindering patient recovery.

"Even when you present clear evidence, it takes time to change habits," said Dr. Prasarn. "But based on the response we received after we presented this at CSRS, I think we could be reaching a turning point."

The Department of Orthopedics and Sports Medicine at Houston Methodist is leading the charge for patient-centered innovation, with ongoing research aimed at improving outcomes and quality of life for patients recovering from injury.

"I think this is a good example of how our team challenges assumptions and advocates for better care," Dr. Prasarn said. "We aren't just following traditions — we are seeking out what's best for the patient."