Much of the durable medical equipment routinely prescribed after cervical spine surgery is not well supported by clinical data, according to an analysis published in the Summer 2026 issue of Vertebral Columns by spine surgeon Arash Sayari, MD, and medical student Mattin Moazzam of Chicago-based Rush University Medical Center, along with spine surgery fellow Aditya Mazmudar, MD, of Chicago-based Midwest Orthopaedics at Rush.
Five things to know:
1. Surgeons keep bracing despite thin evidence. The authors cited a systematic review of 25 studies that found cervical collars improved short-term pain but showed no significant difference in long-term fusion rates between braced and unbraced patients. Even so, they noted, surveys show more than 85% of surgeons still prescribe collars after two-level anterior cervical discectomy and fusion, with only 14% citing the literature as the basis for that practice.
2. Bone growth stimulators show a fading benefit. The review pointed to a randomized trial of 323 higher-risk patients in which pulsed electromagnetic field stimulation produced a higher radiographic fusion rate at six months, 83.6% vs. 68.6%. A cervical-specific trial cited by the authors found that advantage disappeared by 12 months, 92.8% vs. 86.7%, which they said suggests the devices may accelerate fusion rather than change the final rate.
3. The cost and compliance burden is real. The authors wrote that bone stimulators cost several thousand dollars each, typically require insurance preauthorization with documented risk factors and depend on months of daily patient wear that is difficult to monitor or enforce.
4. Secondary modalities vary widely. Among adjunctive devices, the authors found transcutaneous electrical nerve stimulation and photobiomodulation therapy carry the strongest evidence as analgesic aids, though neither improves fusion or structural outcomes. They ranked therapeutic ultrasound lowest, citing a 2025 network meta-analysis of 34 trials and 2,141 patients that found it was the only modality to fail the minimum clinically important threshold for neck pain.
5. The authors urge a selective approach. They recommend reserving collars for higher-risk cases and bone stimulators for patients with identifiable pseudarthrosis risk factors such as nicotine use, multilevel fusion or prior nonunion. Indiscriminate device prescribing, they wrote, risks inflating healthcare spending and patient burden without measurable gains in outcomes, a concern the authors tied to spine care moving deeper into value-based payment.
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