Cervical collar

Last updated
Cervical collar
LateralCollar.JPG
A side view of a person wearing a C spine collar.

A cervical collar, also known as a neck brace, is a medical device used to support and immobilize a person's neck. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, [1] and can be used to treat chronic medical conditions.

Contents

Whenever people have a traumatic head or neck injury, they may have a cervical fracture. This makes them at high risk for spinal cord injury, which could be exacerbated by movement of the person and could lead to paralysis or death. A common scenario for this injury would be a person suspected of having whiplash because of a car accident. [2] In order to prevent further injury, such people may have a collar placed by medical professionals until X-rays can be taken to determine if a cervical spine fracture exists. [3] Medical professionals will often use the NEXUS criteria and/or the Canadian C-spine rules to clear a cervical collar and determine the need for imaging. The cervical collar only stabilizes the top seven vertebrae, C1 through C7. (Other immobilizing devices such as a Kendrick Extrication Device or a backboard can be used to stabilize the remainder of the spinal column. [1] )

The routine use of a cervical collar by a first aid provider is not recommended. [4]

Cervical collars are also used therapeutically to help realign the spinal cord and relieve pain, [5] although they are usually not worn for long periods of time. [6] Another use of the cervical collar is for strains, sprains, or whiplash. [2] [3] If pain is persistent, the collar might be required to remain attached to help in the healing process. [3] [5] A person may also need a cervical collar, or may require a halo fixation device to support the neck during recovery after surgery such as cervical spinal fusion. [7]

Types

A neck collar being placed on a patient by emergency services. Cervical Collar Emergency.jpg
A neck collar being placed on a patient by emergency services.

A soft collar is fairly flexible and is the least limiting but can carry a high risk of further breakage, especially in people with osteoporosis. They are usually made of felt. It can be used for minor injuries or after healing has allowed the neck to become more stable.[ citation needed ]

A range of manufactured rigid collars are also used, usually comprising (a) a firm plastic bi-valved shell secured with Velcro straps and (b) removable padded liners. The also contain a back pad, back panel, front pad, front panel, and chin pad. There is are air holes throughout the device to provide ventilation to the area but also to allow access for a tracheostomy if needed. The rigidness is provided by plexiglass in some models. The most frequently prescribed are the Aspen, Malibu, Miami J, and Philadelphia collars. All these can be used with additional chest and head extension pieces to increase stability.[ citation needed ]

Cervical collars are incorporated into rigid braces that constrain the head and chest together. [8] Examples include the Sterno-Occipital Mandibular Immobilization Device (SOMI), Lerman Minerva and Yale types. Special cases, such as very young children or non-cooperative adults, are sometimes still immobilized in medical plaster of paris casts, such as the Minerva cast.

Rigid collars are most restrictive when flexing the neck and least restrictive with lateral rotation when compared to soft collars. [9] Despite this, subjects have similar range of motion when asked to perform activities of daily living. It is thought that these collars provide a proprioceptive guide on how much to move one's neck and when patients are preoccupied with performing an activity they are able to move their neck more. [10] This is why in more minor injuries, cervical collars are still placed to remind patients of their injury so they can restrict any activities that may worsen their condition.

Application and care

When applying a cervical collar, it must be tight enough to immobilize the neck but must be loose enough to avoid pressure on the vasculature of the neck, strangulation, and pressure ulcers. Ideally, any clothing or jewelry in the neck area should be removed before applying the collar. Next, a collar size must be chosen according to the patient's size and build. The practitioner will then measure the length of the neck. The collar is then placed by one practitioner while the other holds the neck still. Then, the collar should be locked to the ideal neck length according to the specific manufacturer's manual. The chin must be in the chin piece and the collar must extend down to the sternal notch. If the patient has a tracheostomy hole, medical professionals must assure that the hole is midline and accessible in a patient with a cervical collar. Some common errors include incorrect chosen collar size, incorrect technique in placing collar, and incorrect measurement of neck length. [11]

Cervical collars and patient's necks should be evaluated and cleaned frequently for hygienic purposes as well as to avoid pressure ulcers. When the neck area is being cleaned, it is again important for two people to help remove the collar. One person must help hold the neck and keep it aligned while the other unfastens the straps and removes the collar. The area is then cleaned with soap, water, and washcloths. If there is evidence of skin breakdown, other topical agents and even antibiotics may be used if there is evidence of infection as well. [12]

History

The cervical collar was invented in 1966 by George Cottrell during the Vietnam war as a way to provide neck immobilization in American soldiers with potential unstable neck injuries. [13] Its use in the prehospital setting in the United States was popularized by orthopedic surgeon, Dr. JD Farrington. In his paper, "Death in a Ditch", Farrington described seeing "sloppy and inefficient removal of victim[s] from their vehicle." He explained how a standardized approach of applying cervical collars before extracting motor vehicle collision victims from their vehicles is necessary to prevent this. [14]

Use over time

As a result of several small randomized clinical trials over the last decade, hospitals and ambulance staff have seen a significant reduction in the number of patients that are being immobilized. [15] [16] This has been due to complications such as increased intracranial pressure with traumatic brain injury, along with access issues for airway management in obtunded patients. [17] Other risks and complications include increased testing and imaging, increased incidence in displacement of spinal fractures in the elderly, limited physical examination of patients, neck pain, pressure ulcers, and increased length in hospital stay. [18] Because of these potential complications, cervical collars are not recommended in trauma patients with isolated penetrating injury and no neurological deficits. [19] This is because the benefit of a potential secondary cervical injury being prevented with a cervical collar is much less than the risks associated with a cervical collar; with the most concerning being trouble accessing a patient's airway. Some medical professionals have even been calling for a ban on cervical collars, stating that they cause more harm than good. [20] There is also very little evidence that shows cervical collars to be actually making a difference in traumatic cervical spine injury.[ citation needed ]

Other uses

Cervical collars are used much less commonly for things outside of cervical injury and precaution. These uses include cervical radiculopathy, sleep apnea, and patients on CPAP ventilation. Most studies for these conditions are small scale and limited.[ citation needed ]

In a 2009 study, it was shown that patients with a confirmed recent diagnosis of cervical radiculopathy who had a cervical collar applied had greater decrease in pain after 6 weeks compared to patients who did not have one applied. When these patients were followed up after six months, almost all of the subjects had complete or near complete resolution of any pain and/or disability, regardless if they had a cervical collar applied or not. [21]

Sleep apnea can be worsened by anterior flexion of the neck or posterior movement of the mandible when sleeping supine. Cervical collars are used to prevent these movements when sleeping in these patients. Small scale studies have failed to show any improvement in oxygenation, snoring, and/or apneic episodes with the use of cervical collars at night. These patients can experience discomfort and feelings of strangulation at night if the collar is not fastened properly. [22] Despite this, some practitioners still apply cervical collars for sleep apnea.[ citation needed ]

Patients on CPAP ventilation can often have suboptimal positioning due to pain, discomfort, or lack of knowledge. Similarly to patients with sleep apnea, patients on CPAP need optimization of their neck position to keep their airway clear of any obstruction. Specifically, posterior movement of the mandible is to be avoided as to not cause the strap of the CPAP to come off. Also, limited head movement while on CPAP is desired to optimize oxygen flow in and out of the device. Cervical soft collars are used to try to achieve both of these goals. In a small study analyzing the use of cervical collars in patients on CPAP ventilation with a history of sleep apnea, a significant benefit was observed. [23]

Sport

A motocross rider wearing a sports neck brace Antonio Cairoli ITA FMI Yamaha FIM MX Mallory Park 2008 R6a.jpg
A motocross rider wearing a sports neck brace

In high-risk motorsports such as Motocross, go-kart racing and speed-boat racing, racers often wear a protective collar to avoid whiplash and other neck injuries.[ citation needed ]

Designs range from simple foam collars to complex composite devices. [24]

Additional images

See also

Related Research Articles

<span class="mw-page-title-main">Whiplash (medicine)</span> Informal term for injuries to the neck

Whiplash is a non-clinical term describing a range of injuries to the neck caused by or related to a sudden distortion of the neck associated with extension, although the exact injury mechanisms remain unknown. The term "whiplash" is a colloquialism. "Cervical acceleration–deceleration" (CAD) describes the mechanism of the injury, while the term "whiplash associated disorders" (WAD) describes the subsequent injuries and symptoms.

<span class="mw-page-title-main">Airway management</span> Medical procedure ensuring an unobstructed airway

Airway management includes a set of maneuvers and medical procedures performed to prevent and relieve airway obstruction. This ensures an open pathway for gas exchange between a patient's lungs and the atmosphere. This is accomplished by either clearing a previously obstructed airway; or by preventing airway obstruction in cases such as anaphylaxis, the obtunded patient, or medical sedation. Airway obstruction can be caused by the tongue, foreign objects, the tissues of the airway itself, and bodily fluids such as blood and gastric contents (aspiration).

<span class="mw-page-title-main">Major trauma</span> Injury that could cause prolonged disability or death

Major trauma is any injury that has the potential to cause prolonged disability or death. There are many causes of major trauma, blunt and penetrating, including falls, motor vehicle collisions, stabbing wounds, and gunshot wounds. Depending on the severity of injury, quickness of management, and transportation to an appropriate medical facility may be necessary to prevent loss of life or limb. The initial assessment is critical, and involves a physical evaluation and also may include the use of imaging tools to determine the types of injuries accurately and to formulate a course of treatment.

<span class="mw-page-title-main">Clearing the cervical spine</span> Process of determining the existence of a cervical spine injury

Clearing the cervical spine is the process by which medical professionals determine whether cervical spine injuries exist, mainly regarding cervical fracture. It is generally performed in cases of major trauma. This process can take place in the emergency department or in the field by appropriately trained EMS personnel.

<span class="mw-page-title-main">Spinal board</span> Device used in pre-hospital trauma care

A spinal board, is a patient handling device used primarily in pre-hospital trauma care. It is designed to provide rigid support during movement of a person with suspected spinal or limb injuries. They are most commonly used by ambulance staff, as well as lifeguards and ski patrollers. Historically, backboards were also used in an attempt to "improve the posture" of young people, especially girls.

<span class="mw-page-title-main">Spondylosis</span> Degeneration of the vertebral column

Spondylosis is the degeneration of the vertebral column from any cause. In the more narrow sense it refers to spinal osteoarthritis, the age-related degeneration of the spinal column, which is the most common cause of spondylosis. The degenerative process in osteoarthritis chiefly affects the vertebral bodies, the neural foramina and the facet joints. If severe, it may cause pressure on the spinal cord or nerve roots with subsequent sensory or motor disturbances, such as pain, paresthesia, imbalance, and muscle weakness in the limbs.

<span class="mw-page-title-main">Spinal cord injury</span> Injury to the main nerve bundle in the back of humans

A spinal cord injury (SCI) is damage to the spinal cord that causes temporary or permanent changes in its function. Symptoms may include loss of muscle function, sensation, or autonomic function in the parts of the body served by the spinal cord below the level of the injury. Injury can occur at any level of the spinal cord and can be complete, with a total loss of sensation and muscle function at lower sacral segments, or incomplete, meaning some nervous signals are able to travel past the injured area of the cord up to the Sacral S4-5 spinal cord segments. Depending on the location and severity of damage, the symptoms vary, from numbness to paralysis, including bowel or bladder incontinence. Long term outcomes also range widely, from full recovery to permanent tetraplegia or paraplegia. Complications can include muscle atrophy, loss of voluntary motor control, spasticity, pressure sores, infections, and breathing problems.

<span class="mw-page-title-main">Kendrick extrication device</span>

A Kendrick extrication device (KED) is a device used in extrication of victims of traffic collisions from motor vehicles. Commonly carried on ambulances, a KED is typically used by an emergency medical technician, paramedic, or another first responder. It was originally designed for extrication of race car drivers. Typically used in conjunction with a cervical collar, a KED is a semi-rigid brace that secures the head, neck and torso in an anatomically neutral position. Its use is claimed to reduce the possibility of additional injuries to these regions during extrication, although its value has been questioned, as there is a lack of evidence to support its use. The original KED was designed by Richard Kendrick in 1978.

<span class="mw-page-title-main">Scoop stretcher</span> Device used for moving injured people

The scoop stretcher is a device used specifically for moving injured people. It is ideal for carrying casualties with possible spinal injuries.

<span class="mw-page-title-main">Cervical fracture</span> Medical condition

A cervical fracture, commonly called a broken neck, is a fracture of any of the seven cervical vertebrae in the neck. Examples of common causes in humans are traffic collisions and diving into shallow water. Abnormal movement of neck bones or pieces of bone can cause a spinal cord injury, resulting in loss of sensation, paralysis, or usually death soon thereafter, primarily via compromising neurological supply to the respiratory muscles as well as innervation to the heart.

<span class="mw-page-title-main">Spinal disc herniation</span> Injury to the connective tissue between spinal vertebrae

A spinal disc herniation is an injury to the cushioning and connective tissue between vertebrae, usually caused by excessive strain or trauma to the spine. It may result in back pain, pain or sensation in different parts of the body, and physical disability. The most conclusive diagnostic tool for disc herniation is MRI, and treatment may range from painkillers to surgery. Protection from disc herniation is best provided by core strength and an awareness of body mechanics including posture.

<span class="mw-page-title-main">Radiculopathy</span> Medical condition

Radiculopathy, also commonly referred to as pinched nerve, refers to a set of conditions in which one or more nerves are affected and do not work properly. Radiculopathy can result in pain, weakness, altered sensation (paresthesia) or difficulty controlling specific muscles. Pinched nerves arise when surrounding bone or tissue, such as cartilage, muscles or tendons, put pressure on the nerve and disrupt its function.

<span class="mw-page-title-main">Neck pain</span> Medical condition

Neck pain, also known as cervicalgia, is a common problem, with two-thirds of the population having neck pain at some point in their lives.

Chiropractors use their version of spinal manipulation as their primary treatment method, with non-chiropractic use of spinal manipulation gaining more study and attention in mainstream medicine in the 1980s. There is no evidence that chiropractic spinal adjustments are effective for any medical condition, with the possible exception of treatment for lower back pain. The safety of manipulation, particularly on the cervical spine has been debated. Adverse results, including strokes and deaths, are rare.

Grady straps are a specific strapping configuration used in full body spinal immobilization.

<span class="mw-page-title-main">Spinal stenosis</span> Disease of the bony spine that results in narrowing of the spinal canal

Spinal stenosis is an abnormal narrowing of the spinal canal or neural foramen that results in pressure on the spinal cord or nerve roots. Symptoms may include pain, numbness, or weakness in the arms or legs. Symptoms are typically gradual in onset and improve with leaning forward. Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction.

<span class="mw-page-title-main">Spinal precautions</span> Efforts to prevent movement of the spine in those with a risk of a spine injury

Spinal precautions, also known as spinal immobilization and spinal motion restriction, are efforts to prevent movement of the spine in those with a risk of a spine injury. This is done as an effort to prevent injury to the spinal cord. It is estimated that 2% of people with blunt trauma will have a spine injury.

Spinal cord injury without radiographic abnormality (SCIWORA) is symptoms of a spinal cord injury (SCI) with no evidence of injury to the spinal column on X-rays or CT scan. Symptoms may include numbness, weakness, abnormal reflexes, or loss of bladder or bowel control. Neck or back pain is also common. Symptoms may be brief or persistent. Some do not develop symptoms until a few days after the injury.

<span class="mw-page-title-main">Cervicocranial syndrome</span> Medical condition

Cervicocranial syndrome or is a neurological illness. It is a combination of symptoms that are caused by an abnormality in the neck. The bones of the neck that are affected are cervical vertebrae. This syndrome can be identified by confirming cervical bone shifts, collapsed cervical bones or misalignment of the cervical bone leading to improper functioning of cervical spinal nerves.Greenberg Regenerative Medicine | Bryn Mawr, Pennsylvania Cervicocranial syndrome is either congenital or acquired. Some examples of diseases that could result in cervicocranial syndrome are Chiari disease, Klippel-Feil malformation osteoarthritis, and trauma. Treatment options include neck braces, pain medication and surgery. The quality of life for individuals suffering from CCJ syndrome can improve through surgery.

Craniocervical instability (CCI) is a medical condition characterized by excessive movement of the vertebra at the atlanto-occipital joint and the atlanto-axial joint located between the skull and the top two vertebra, known as C1 and C2. The condition can cause neuron injury and compression of nearby structures, including the brain stem, spinal cord, vagus nerve, and vertebral artery, resulting in a constellation of symptoms.

References

  1. 1 2 Mistovich JJ, Hafen BQ, Karren KJ (2000). Brady Prehospital Emergency Care (6 ed.). Upper Saddle River, NJ: Prentice-Hall. pp.  662. ISBN   978-0-8359-6064-9.
  2. 1 2 DerSarkissian C, ed. (14 April 2021). "Whiplash". WebMD . Retrieved 2008-03-07.
  3. 1 2 3 "Neck Strains". WebMD. Archived from the original on 3 January 2008. Retrieved 2008-03-07.
  4. ↑ Zideman DA, De Buck ED, Singletary EM, Cassan P, Chalkias AF, Evans TR, et al. (October 2015). "European Resuscitation Council Guidelines for Resuscitation 2015 Section 9. First aid". Resuscitation. 95: 278–287. doi: 10.1016/j.resuscitation.2015.07.031 . PMID   26477417.
  5. 1 2 Watson S (21 April 2021). Wheeler T (ed.). "Physical Therapy and Other Options for Neck Pain". WebMD . Retrieved 2008-03-07.
  6. ↑ "Office Ergonomics - Other Treatment for Injuries Related to the Workstation". WebMD. Archived from the original on 2008-03-28. Retrieved 2008-03-07.
  7. ↑ "Cervical spinal fusion". WebMD. Archived from the original on 2008-03-30. Retrieved 2008-03-07.
  8. ↑ Kulkarni SS, Meier III RH (1 November 2018). "Spinal Orthotics". Medscape.
  9. ↑ Barati K, Arazpour M, Vameghi R, Abdoli A, Farmani F (June 2017). "The Effect of Soft and Rigid Cervical Collars on Head and Neck Immobilization in Healthy Subjects". Asian Spine Journal. 11 (3): 390–395. doi:10.4184/asj.2017.11.3.390. PMC   5481593 . PMID   28670406.
  10. ↑ Miller CP, Bible JE, Jegede KA, Whang PG, Grauer JN (June 2010). "Soft and rigid collars provide similar restriction in cervical range of motion during fifteen activities of daily living". Spine. 35 (13): 1271–1278. doi:10.1097/BRS.0b013e3181c0ddad. PMID   20512025. S2CID   11231196.
  11. ↑ Kreinest M, Goller S, Rauch G, Frank C, Gliwitzky B, Wölfl CG, et al. (2015-11-20). Shamji M (ed.). "Application of Cervical Collars - An Analysis of Practical Skills of Professional Emergency Medical Care Providers". PLOS ONE. 10 (11): e0143409. Bibcode:2015PLoSO..1043409K. doi: 10.1371/journal.pone.0143409 . PMC   4654515 . PMID   26587650.
  12. ↑ Nash J (October 2015). "Cervical Collar: Skin Care Needs of the Patient Wearing a Cervical Collar" (PDF). Barnes-Jewish Hospital.
  13. ↑ US3285244A,Cottrell, George W.,"Cervical collar",issued 1966-11-15
  14. ↑ "No place for the rigid cervical collar in pre-hospital care". International Paramedic Practice. Retrieved 2022-12-16.
  15. ↑ Rogers L (2017). "No place for the rigid cervical collar in pre-hospital care". International Paramedic Practice. 7 (1): 12–15. doi:10.12968/ippr.2017.7.1.12. ISSN   2052-4889.
  16. ↑ Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K (March 2014). "Prehospital use of cervical collars in trauma patients: a critical review". Journal of Neurotrauma. 31 (6): 531–540. doi:10.1089/neu.2013.3094. PMC   3949434 . PMID   23962031.
  17. ↑ Patel MB, Humble SS, Cullinane DC, Day MA, Jawa RS, Devin CJ, et al. (February 2015). "Cervical spine collar clearance in the obtunded adult blunt trauma patient: a systematic review and practice management guideline from the Eastern Association for the Surgery of Trauma". The Journal of Trauma and Acute Care Surgery. 78 (2): 430–441. doi:10.1097/ta.0000000000000503. PMC   4409130 . PMID   25757133.
  18. ↑ Maschmann C, Jeppesen E, Rubin MA, Barfod C (August 2019). "New clinical guidelines on the spinal stabilisation of adult trauma patients - consensus and evidence based". Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 27 (1): 77. doi: 10.1186/s13049-019-0655-x . PMC   6700785 . PMID   31426850.
  19. ↑ Connell RA, Graham CA, Munro PT (December 2003). "Is spinal immobilisation necessary for all patients sustaining isolated penetrating trauma?". Injury. 34 (12): 912–914. doi:10.1016/S0020-1383(03)00070-6. PMID   14636733.
  20. ↑ Plumb JO, Morris CG (January 2013). "Cervical collars: probably useless; definitely cause harm!". The Journal of Emergency Medicine. 44 (1): e143. doi:10.1016/j.jemermed.2012.05.031. PMID   22883718.
  21. ↑ Dmytriv M, Rowland K, Gavagan T, Holub D (May 2010). "PT or cervical collar for cervical radiculopathy?". The Journal of Family Practice. 59 (5): 269–272. PMC   3183940 . PMID   20544046.
  22. ↑ Bordier P, Lataste A, Orazio S, Papin J, Robert F, Bourenane G (January 2021). "Soft cervical collar in obstructive sleep apnoea: a pilot study". ERJ Open Research. 7 (1): 00431–2020. doi:10.1183/23120541.00431-2020. PMC   7950809 . PMID   33732743.
  23. ↑ Prigent A, Grassion L, Guesdon S, Gonzalez-Bermejo J (December 2017). "Efficacy of the Addition of a Cervical Collar in the Treatment of Persistent Obstructive Apneas Despite Continuous Positive Airway Pressure". Journal of Clinical Sleep Medicine. 13 (12): 1473–1476. doi:10.5664/jcsm.6852. PMC   5695995 . PMID   28728616.
  24. ↑ "Valhalla Adult 360 Plus Device Karting Neck Brace" . Retrieved 2010-08-16.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.