From the Guidelines
Rigid cervical collars are the primary tool used to stabilize the cervical spine in cases of suspected neck injury, despite limited evidence supporting their efficacy in limiting cervical spinal movement and improving outcomes in terms of neurological injury or mortality. The use of rigid cervical collars is based on expert consensus and tradition, as noted in the 2015 international consensus on first aid science with treatment recommendations 1. However, recent studies have raised concerns about the effectiveness of cervical collars in preventing secondary spinal cord injury, with some evidence suggesting that they may even cause greater cervical spine movement in certain situations 1.
Some key points to consider when using rigid cervical collars include:
- They provide firm support to restrict movement and prevent further injury to the cervical vertebrae and spinal cord
- They are designed to maintain neutral alignment of the spine and are essential in pre-hospital care and initial management of trauma patients
- The presence of rigid/semi-rigid collars during tracheal intubation is associated with an increased incidence of difficult tracheal intubation, primarily due to a reduction in mouth opening 1
- There is very limited, low-quality evidence supporting the efficacy of cervical collars with regards to limitation of cervical spinal movement, and no evidence of improved outcomes in terms of neurological injury or mortality 1
According to the most recent and highest quality study, the use of rigid cervical collars should be approached with caution, and their removal should be considered in certain situations, such as during tracheal intubation attempts, to minimize movement to the cervical spine 1. Overall, while rigid cervical collars are currently the standard of care for acute cervical spine immobilization in emergency situations, their use should be guided by the latest evidence and clinical judgment.
From the Research
Cervical Spine Stabilization Methods
- Cervical spine immobilization devices, such as soft collars, hard collars, extrication collars, and Philadelphia collars, are used to stabilize the cervical spine and prevent neurologic deficits associated with unstable fractures 2.
- Hard collars, including the Philadelphia collar, are effective in limiting extension and rotation movements, while soft collars are not significantly better than no collar in terms of range of motion 2, 3.
- The combination of sandbags, tape, and a Philadelphia collar is significantly more effective in reducing extension movements than other methods used alone 2.
- Rigid collars provide significant higher stability compared to no collar and to soft collars in flexion/extension and rotation movements, but clinical studies have not confirmed a difference in neurological outcome 3.
Complications and Considerations
- The use of hard cervical collars can lead to complications such as occipital pressure ulceration, impaired activities of daily living, and impaired sleep 4, 5.
- Soft collars have been proposed as a good alternative to rigid collars due to the complications related to rigid collars 3.
- The decision to use a hard collar or other immobilization method should be individualized based on the patient's specific condition and needs, and should take into account the potential risks and benefits 6, 5.
Surgical Stabilization Techniques
- Various surgical techniques, including internal fixation devices and external immobilization, are used to stabilize the cervical spine in patients with unstable fractures or other conditions 6.
- The choice of surgical technique depends on the specific condition being treated and the individual patient's needs, and should be based on a thorough understanding of spinal biomechanics and bone graft properties 6.