Author: Richard H. Adler

Immobilization collars are a "good" and integral part of treatment for people with suspected or confirmed fractures of their cervical spine to prevent neurologic damage during transportation from the traumatic injury scene for treatment. These collars can also provide an important reminder to the injured person of their injuries to prevent additional injury from unprotected or rapid movements of the neck during times of distraction while at home, at work or in a car.

The "bad" in the use of cervical collars on injured people comes when the collar is improperly placed or the injured person is given incorrect instructions during the initial immobilization phase causing problems. For example, if the injured person is braced in flexion it can cause muscle spasm of the longus colli and longus capitis - the muscle largely responsible for the reversed cervical lordotic curve. This causes the abnormal forward position of the head relative to the body's center of gravity to increase, placing greater demands on the erector spine musculature, and may cause or contribute to the development of myofascial pain disorder.¹ Other studies have shown the "ugly" fact traumatic injury victims can be susceptible to a wide variety of secondary injuries if the neck collar is improperly applied. Some of the studies to be aware of include:

1. A study performed by multiple research teams including the Department of Anaesthetic at Pilgrim Hospital in Boston Lincolnshire, University of Washington, University of Hong Kong and Prince Wales Hospital. Each research team conducted independent studies to determine if neck immobilization collars compressed the injured person's internal jugular veins. The researchers also looked for any change in intracranial pressure in the brain when brain injured persons were given the cervical collar wearing the neck collar. Each research team discovered a significant elevation of cerebrospinal fluid pressure in the brain of nearly all the subjects who wore a cervical collar. The study appeared to establish cervical collars may contribute to neurological injury, particularly in head injured patients who already have reduced intracranial pressure.²
2. The Department of Otolaryngology and Head and Neck Surgery at Royal Preston Hospital in Lancashire, UK conducted a separate study which found tight fitting neck immobilization collars can restrict laryngeal movement during swallowing causing dysphagia, which can be mistaken for damage to neuromuscular function.³
3. The Department of Emergency Medicine in East Carolina Medicine in Greenville, NC conducted a study which found cervical immobilization collars caused changes in physical exam findings if worn for long periods of time. In this study, twenty healthy people without a history of back pain or injuries were placed in collars for one hour. Three patients had tenderness over their cervical vertebrae within forty minutes. Five people developed vertebrae point tenderness after sixty minutes. Eighteen of twenty people in the study complained of increasing discomfort over time. The researchers concluded emergency doctors should conduct their evaluation immediately to avoid false positive results which could be generated by use of the cervical immobilization collar for 40 minutes or more.⁴
4. Finally, Surgeons from Yamagata University School of Medicine in Japan discovered palsy of the brachial plexus and facial nerve may occur when wearing an immobilization device during a lobectomy. A cervical collar had been placed on the patient for the purpose of cervical immobilization during lung cancer surgery. When post surgical problems developed, it was concluded the palsy likely occurred as a result of injury caused by the cervical collar pressing strongly upon the neck and lower jaw causing a stretching of the brachial plexus and facial nerve.⁵
   
   These studies provide a victim of traumatic neck injury and their doctors with some "take home" lessons which can be summarized as follows:
   
   
   A. Cervical collars alone should never be viewed as a treatment regimen;
   
   B. Cervical collars used in conjunction with soft tissue neck injuries should be prescribed for use only by doctors who understand the importance of properly applied collars accompanied by good patient instructions for use;
   
   C. Cervical collars should be used on a short term basis only; and
   
   D. Doctors who prescribe soft cervical collars need to monitor the patients closely.
   
   1. Foreman and Croft. Whiplash Injuries: The Cervical Acceleration/Deceleration Syndrome. 3rd Edition, 527.
   2. Anaesthesia. 1994 May; 49 (5): 437-439. Effects of the cervical collar on cerebrospinal fluid pressure. Similar findings were produced in 2 other studies: ANZ Journal of Surgery. Volume 72 Issue 6 page 389 - June 2002; The Journal of Trauma. Volume 53 (6) December 2002 Page 1185-1188.
   3. Br L Neurosurg. 1996 Oct; 10 (5): 501-502. Dysphagia caused by a hard cervical collar.
   
   4. Prehosp Emerg Care. 2002 Oct-Dec; 6(4):421-4. Changes in physical examination caused by use of spinal immobilization.
   
   5. Masui. 2002 Aug; 51 (8): 892-895. A case of postoperative palsy of the brachial plexus and facial nerve caused by the use of Cervical Collar During Lung surgery.