What is used to stabilize the cervical spine?

From the Guidelines

A rigid cervical collar is the primary device used to stabilize the cervical spine in cases of suspected neck injury, despite limited evidence supporting its efficacy in limiting cervical spinal movement and improving outcomes. The use of cervical collars has been a topic of debate, with some studies suggesting that they may not provide significant benefits in terms of reducing neurologic injury or mortality 1. However, they are still widely used in emergency situations to provide crucial support and limit movement of the cervical vertebrae, helping to prevent further injury.

Key Points to Consider

• Rigid collars are designed to restrict flexion, extension, and rotation of the neck, and are typically used in emergency situations, such as after trauma or accidents, where there's a possibility of cervical spine injury.
• 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.
• Recent guidelines suggest that during tracheal intubation attempts, a semi-rigid or rigid cervical collar should be removed, which can be done most easily by only removing the anterior part of the collar; this will also help minimise any movement to the cervical spine 1.

Recommendations for Practice

• Healthcare providers should be trained in the proper application of rigid cervical collars to ensure effective immobilization and patient safety.
• The use of cervical collars should be carefully considered, taking into account the potential benefits and risks, and alternative methods of cervical spine stabilization should be explored.
• Further research is needed to determine the effectiveness of cervical collars in preventing neurologic injury and improving outcomes in patients with suspected cervical spine injury.

From the Research

Cervical Spine Stabilization Methods

• Cervical spine immobilization devices, such as soft collars, hard collars, extrication collars, Philadelphia collars, and bilateral sandbags with tape, are used to stabilize the cervical spine and prevent neurologic deficits associated with unstable fractures 2.
• The combination of sandbags, tape, and a Philadelphia collar was found to be significantly more effective in reducing extension 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 3.
• The halo vest was found to be the most effective in providing immobilization in the intact and unstable upper cervical spine, although it may not be suitable for all patients due to pin track problems and lack of patient compliance 4.

Comparison of Cervical Immobilization Devices

• Soft collars have been proposed as a good alternative to rigid collars due to the complications related to rigid collars, but they do not provide significant stability in flexion/extension and rotation movements 3.
• Hard collars are commonly used in the management of spinal trauma and as an adjunct to recovery after elective cervical spine surgery, but there is little evidence to support their use in reducing the risk of non-union and pain 5.
• The choice of cervical immobilization device depends on the individual patient's needs and the specific injury or condition being treated, and may involve a combination of different devices and techniques 6.

Clinical Applications

• Cervical spine stabilization is crucial in the management of spinal trauma and in the prevention of neurologic deficits associated with unstable fractures 2, 3.
• The use of cervical immobilization devices is also important in the post-operative management of patients undergoing elective cervical spine surgery, although the evidence for their use is limited 5.
• Further research is needed to develop guidelines for the use of cervical immobilization devices and to standardize practice in the management of cervical spine injuries and conditions 5.