A cervical collar, also known as a neck brace, is a
medical device
A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assura ...
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,
and can be used to treat chronic medical conditions.
Whenever people have a
trauma
Trauma most often refers to:
* Major trauma, in physical medicine, severe physical injury caused by an external source
* Psychological trauma, a type of damage to the psyche that occurs as a result of a severely distressing event
*Traumatic i ...
tic head or neck injury, they may have a
cervical fracture
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 pie ...
. This makes them at high risk for
spinal cord injury
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 cor ...
, 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
Whiplash may refer to:
* The long flexible part of a whip
* Whiplash (medicine), a neck injury
** Whiplash Injury Protection System (WHIPS), in automobiles
Film and television
* ''Whiplash'' (1948 film), a US film noir about a boxer
* ''Whiplas ...
because of a
car accident.
In order to prevent further injury, such people may have a collar placed by medical professionals until
X-ray
An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...
s can be taken to determine if a
cervical spine fracture exists.
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
The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic i ...
, C1 through C7. (Other immobilizing devices such as a
Kendrick Extrication Device
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 re ...
or a
backboard can be used to stabilize the remainder of the spinal column.
)
The routine use of a cervical collar by a first aid provider is not recommended.
Cervical collars are also used therapeutically to help realign the spinal cord and relieve pain,
although they are usually not worn for long periods of time.
Another use of the cervical collar is for
strains,
sprain
A sprain, also known as a torn ligament, is an acute soft tissue injury of the ligaments within a joint, often caused by a sudden movement abruptly forcing the joint to exceed its functional range of motion. Ligaments are tough, inelastic fibers ...
s, or
whiplash
Whiplash may refer to:
* The long flexible part of a whip
* Whiplash (medicine), a neck injury
** Whiplash Injury Protection System (WHIPS), in automobiles
Film and television
* ''Whiplash'' (1948 film), a US film noir about a boxer
* ''Whiplas ...
.
If pain is persistent, the collar might be required to remain attached to help in the healing process.
A person may also need a cervical collar, or may require a
halo fixation device to support the neck during
recovery
Recovery or Recover may refer to:
Arts and entertainment Books
* ''Recovery'' (novel), a Star Wars e-book
* Recovery Version, a translation of the Bible with footnotes published by Living Stream Ministry
Film and television
* ''Recovery'' (fil ...
after surgery such as
cervical spinal fusion.
Types
![Cervical Collar Emergency](https://upload.wikimedia.org/wikipedia/commons/b/bc/Cervical_Collar_Emergency.jpg)
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
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone ...
. They are usually made of felt. It can be used for minor injuries or after healing has allowed the neck to become more stable.
A range of manufactured rigid collars are also used, usually comprising (a) a firm plastic bi-valved shell secured with
Velcro
Velcro, officially known as Velcro IP Holdings LLC and trading as Velcro Companies, is a British privately held company, founded by Swiss electrical engineer George de Mestral in the 1950s. It is the original manufacturer of hook-and-loop fasten ...
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
Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The r ...
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.
Cervical collars are incorporated into rigid braces that constrain the head and chest together. 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. 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. 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.
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.
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. 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
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.
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. This has been due to
complications such as increased
intracranial pressure
Intracranial pressure (ICP) is the pressure exerted by fluids such as cerebrospinal fluid (CSF) inside the skull and on the brain tissue. ICP is measured in millimeters of mercury (mmHg) and at rest, is normally 7–15 Millimeter of mercury, mmHg ...
with
traumatic brain injury
A traumatic brain injury (TBI), also known as an intracranial injury, is an injury to the brain caused by an external force. TBI can be classified based on severity (ranging from mild traumatic brain injury TBI/concussionto severe traumatic b ...
, along with access issues for airway management in obtunded patients. 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. Because of these potential complications, cervical collars are not recommended in trauma patients with isolated penetrating injury and no neurological deficits. 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. There is also very little evidence that shows cervical collars to be actually making a difference in traumatic cervical spine injury.
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
Continuous positive airway pressure (CPAP) is a form of positive airway pressure (PAP) ventilation in which a constant level of pressure greater than atmospheric pressure is continuously applied to the upper respiratory tract of a person. The ap ...
ventilation. Most studies for these conditions are small scale and limited.
In a 2009 study, it was shown that patients with a confirmed recent diagnosis of
cervical radiculopathy
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 (a neuropathy). Radiculopathy can result in pain (radicular pain), weakness, altered sens ...
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.
Sleep apnea
Sleep apnea, also spelled sleep apnoea, is a sleep disorder in which pauses in breathing or periods of shallow breathing during sleep occur more often than normal. Each pause can last for a few seconds to a few minutes and they happen many times ...
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. Despite this, some practitioners still apply cervical collars for sleep apnea.
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.
Sport
![Antonio Cairoli ITA FMI Yamaha FIM MX Mallory Park 2008 R6a](https://upload.wikimedia.org/wikipedia/commons/3/3c/Antonio_Cairoli_ITA_FMI_Yamaha_FIM_MX_Mallory_Park_2008_R6a.jpg)
In high-risk motorsports such as
Motocross
Motocross is a form of off-road motorcycle racing held on enclosed off-road circuits. The sport evolved from motorcycle trials competitions held in the United Kingdom.
History
Motocross first evolved in Britain from motorcycle trials competi ...
,
go-kart racing
Kart racing or karting is a road racing variant of motorsport with open-wheel, four-wheeled vehicles known as go-karts or shifter karts. They are usually raced on scaled-down circuits, although some professional kart races are also held on ful ...
and
speed-boat racing
Boat racing is a sport in which boats, or other types of watercraft, race on water. Boat racing powered by oars is recorded as having occurred in ancient Egypt, and it is likely that people have engaged in races involving boats and other wate ...
, racers often wear a protective collar to avoid
whiplash
Whiplash may refer to:
* The long flexible part of a whip
* Whiplash (medicine), a neck injury
** Whiplash Injury Protection System (WHIPS), in automobiles
Film and television
* ''Whiplash'' (1948 film), a US film noir about a boxer
* ''Whiplas ...
and other neck injuries.
Designs range from simple foam collars to complex composite devices.
Additional images
File:Lateral Collar.JPG, Side view of a cervical collar
File:APCollar.JPG, Front view of a cervical collar. The opening provides anterior access to the neck for a cricothyrotomy
A cricothyrotomy (also called cricothyroidotomy) is an incision made through the skin and cricothyroid membrane to establish a patent airway during certain life-threatening situations, such as airway obstruction by a foreign body, angioedema, or ...
or tracheotomy
Tracheotomy (, ), or tracheostomy, is a surgical airway management procedure which consists of making an incision (cut) on the anterior aspect (front) of the neck and opening a direct airway through an incision in the trachea (windpipe). The r ...
.
File:Medical X-Ray imaging RAH06 nevit.jpg, Side view X-ray of the neck with a cervical collar.
File:SOMI Brace.png, SOMI brace.
File:Cervical Collar.png, Cervical collar.
File:Military neck trauma simulation.jpg, Neck collar attachment during a military simulation, replacing manual stabilization of the head.
File:Philadelphia collar.JPG, Woman wearing a Philadelphia cervical collar
See also
*
Vertebrae
The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic i ...
*
Orthotics
Orthotics ( el, Ορθός, translit=ortho, lit=to straighten, to align) is a medical specialty that focuses on the design and application of orthoses, or braces. An is "an externally applied device used to influence the structural and functio ...
*
Dental braces
Dental braces (also known as braces, orthodontic cases, or cases) are devices used in orthodontics that align and straighten teeth and help position them with regard to a person's bite, while also aiming to improve dental health. They are often ...
*
Orthopedic cast
An orthopedic cast, or simply cast, is a shell, frequently made from plaster or fiberglass, that encases a limb (or, in some cases, large portions of the body) to stabilize and hold anatomical structures—most often a broken bone (or bones), in ...
*
Kendrick Extrication Device
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 re ...
*
Long spine board
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, ...
*
Halo (medicine)
Orthotics ( el, Ορθός, translit=ortho, lit=to straighten, to align) is a medical specialty that focuses on the design and application of orthoses, or braces. An is "an externally applied device used to influence the structural and functio ...
*
Spinal fusion
Spinal fusion, also called spondylodesis or spondylosyndesis, is a neurosurgical or orthopedic surgical technique that joins two or more vertebrae. This procedure can be performed at any level in the spine (cervical, thoracic, or lumbar) and pre ...
*
Back brace
A back brace is a device designed to limit the motion of the spine in cases of bone fracture or in post-operative spinal fusiona, as well as a preventative measure against some progressive conditions or to correct patient posture.
Common back br ...
References
{{Reflist, 30em
Bones
Emergency medical equipment
Orthopedic braces
Protective gear