Injuries to the cervical spine are common in trauma patients. Traffic accidents, sports accidents, and falls are among the leading causes of trauma injuries. In such scenarios, immobilization of the cervical spine with the right use of cervical collar is important.
Cervical collar or neck collar is now called cervical orthosis. The orthosis is worn around the neck, and fits everywhere from the jaw to the chest. It helps to restrict movement and acts as a support to the neck while healing from a cervical injury, fracture, or surgery.
The cervical collar will serve to decrease muscle spasms, align the neck at the center with the chin elevated slightly. It also provides support to the injured area, increasing stability and preventing further injuries.
It also reduces pains after spinal injury, post-op surgery, or in degenerative diseases that affect the neck strength.
Additionally, by immobilizing the c-spine, it limits motion by restricting neck flexion, extension, and lateral tilt (bending & rotation) but does not restrict axial loading.
Types of Cervical Collars
There are three main types of cervical collars: soft, semi-rigid and rigid.
Soft Cervical Collar
These types are made from thick foam rubber covered in cotton material. It comes in different hardness, and can be washed. The foam material is soft, elastic, breathable, comfortable, and can be used for sleeping.
It is used as a neck support, to treat minor neck strains, and control pain and pressure after an injury like whiplash. It can stabilize the cervical spine, improve recovery after surgery, torticollis, and poor head posture.
This type does not seem to increase the risk for secondary spinal injuries.
Rigid Cervical Collars
Made from molded plastic with a removable padded liner in two pieces – a front and back piece, fastened with Velcro. When it is applied and secured, the collar creates a rigid orthosis which supports the head and neck.
A hard cervical collar fit from your chin to the sternum or breastbone. It extends from the base of your head down to the top of your back. The top of the collar may also fit tightly around the lower jaw.
Some common products include the Philadelphia® collar, Miami J® collar, and Aspen® collar.
Rigid collar can cause complications and morbidity when used to immobilize a patient. Some of those complications are discomfort, increased intracranial pressure, impaired ventilation, masking of neck/occipital injuries, pressure areas, risk of aspiration, and worsening of spinal cord injury (e.g., in ankylosing spondylitis)
This type is made from soft semi-rigid foam (mid-density polyurethane foam) and restricts cervical motion control but does not reduce mobility. It is used in conditions such as whiplash, acute neck injuries, neck extension injuries, cervical spondylosis, arthritis in the neck, and rheumatoid arthritis.
It may cause limitation in coughing, swallowing, breathing, vomiting and potentially aspiration
May increase cranial pressure
Improper cervical immobilization can cause additional spinal cord injuries during hospitalization
May increase exposure to transmission of blood-borne diseases.
May result in skin damage especially occiput, shoulders, chin and mandible, ears, sternum, laryngeal prominence, and macerated neck skin, and the risk of pressure ulcers.
Delays intubation or difficulty weaning from the ventilator
May lead to marginal mandibular nerve palsy (cranial nerve VII), and long-term sensory compromise.
Lack of mobility may increase the risks of deep vein thrombosis, pneumonia, ileus. It can also cause the breakdown of sacral pressure points, heel, and elbow.
Can cause anxiety and discomfort.
Contraindications
Severe neck injuries like cervical vertebral fractures
In cases of massive soft tissue swelling in the neck.
