From the Guidelines
The workup for a frozen neck, or cervical spine immobilization, should prioritize minimizing cervical spine movement, and the use of bilateral sandbags held together with tape over the forehead is the only proven method of cervical spine immobilization, as stated in the 2010 American Heart Association and American Red Cross International Consensus on First Aid Science with Treatment Recommendations 1.
The management of a frozen neck requires careful consideration of the potential risks and benefits of various diagnostic and therapeutic interventions. In the context of trauma, the primary concern is to minimize the risk of further injury to the cervical spine.
- The use of cervical collars is not recommended by first aid providers due to the potential for secondary injury and the lack of evidence supporting their effectiveness in reducing cervical spine movement 1.
- In patients with suspected or confirmed cervical spine injury, attempts should be made to minimize cervical spine movement during pre-oxygenation and facemask ventilation, and jaw thrust should be used rather than head tilt plus chin lift 1.
- Videolaryngoscopy should be used for tracheal intubation in patients with suspected or confirmed cervical spine injury, and clinicians should receive regular training in the use of videolaryngoscopy with cervical spine immobilization 1.
In terms of diagnostic imaging, the evidence suggests that MRI is highly sensitive in detecting soft tissue injury, but its use is not recommended as a routine screening tool due to the high cost and the potential for false positive results 1.
- A normal MRI scan does not necessarily rule out the presence of a cervical spine injury, and the correlation between MRI findings and acknowledged standards is often poor 1.
- The use of plain films and CT scans is recommended for evaluating the cervical spine in trauma patients, as they are more effective in detecting unstable injuries and have a lower risk of false positive results 1.
Overall, the management of a frozen neck requires a careful and nuanced approach, taking into account the potential risks and benefits of various diagnostic and therapeutic interventions. The use of bilateral sandbags held together with tape over the forehead remains the only proven method of cervical spine immobilization, and should be prioritized in the management of patients with suspected or confirmed cervical spine injury 1.
From the Research
Diagnostic Approach for Cervical Spine Immobilization
The workup for a frozen neck, or cervical spine immobilization, typically involves a combination of imaging modalities to evaluate the osseous and soft tissue structures.
- Initial evaluation often begins with computed tomography (CT) for osseous and basic soft tissue evaluation, as it provides high sensitivity for detecting traumatic c-spine injury 2.
- Magnetic resonance imaging (MRI) is used as a complementary evaluation for neural structures and soft tissues, and has been shown to be particularly useful in identifying injuries not recognized by CT in symptomatic patients 3, 4, 2.
- MRI has been found to be a safe and reliable method for evaluating the cervical spine for nonapparent injury in comatose or obtunded trauma patients, with sagittal T1- and T2-weighted MR imaging being a useful approach 4.
Imaging Modalities
The following imaging modalities have been studied for their effectiveness in evaluating cervical spine trauma:
- CT: high sensitivity for detecting traumatic c-spine injury, but may not identify all injuries 2.
- MRI: useful for identifying injuries not recognized by CT, particularly in symptomatic patients 2.
- X-Ray: insufficient for accurately ruling out c-spine injury, with low sensitivity 2.
- LODOX: also insufficient for accurately ruling out c-spine injury, with very low sensitivity 2.
Clinical Relevance
The choice of imaging modality depends on the clinical presentation and the need for detailed evaluation of soft tissues and neural structures.