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Cervical collars in patients requiring spinal immobilisation
  1. John Butler,
  2. Damien Bates
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
  1. Correspondence to: Kevin Mackway-Jones, Consultant (kevin.mackway-jones{at}man.ac.uk)

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Report by John Butler, Specialist Registrar Search checked by , Damien Bates, Specialist Registrar

Clinical scenario

A paramedic crew brings a 27 year old patient with a suspected cervical spine injury to the emergency department after an RTA. At the scene of the accident the patient had full spinal immobilisation, which consisted of a long spinal board, a correctly sized cervical collar, and head blocks with straps to secure the head to the board. In the emergency department the patient is becoming increasingly distressed by the presence of the neck collar and requests that it is removed. You wonder whether the cervical collar provides any additional benefit in terms of immobilising the spine.

Three part question

In [patients requiring full spinal immobilisation] is [the use of a cervical collar, long board and head blocks better than long board and head blocks alone] at [cervical spinal immobilisation]?

Search strategy

Medline 1966–03/01 using the OVID interface and hand searching relevant pre-hospital journals. {(exp spinal injuries OR spinal injury$.mp OR back injuries OR back injury$.mp OR exp neck injuries OR neck injury$.mp OR exp spinal cord injuries OR spinal cord injury$.mp OR exp spinal fractures OR spinal fracture$.mp OR exp lumbar vertebrae OR lumbar spine injury$.mp OR exp thoracic vertebrae OR thoracic spine injury$.mp OR exp cervical vertebrae OR vertebral fracture$.mp OR cervical spinal injury$.mp OR exp multiple trauma OR multiple trauma.mp OR exp wounds and injuries OR trauma.mp) AND (exp immobilization OR spine boards$.mp OR neck collar$.mp OR spinal immobilization$.mp OR cervical collar$.mp OR hard collar$.mp OR semi-rigid collar$.mp OR rigid collar$.mp)} LIMIT to human AND english.

Search outcome

Altogether 855 papers found of which 854 were irrelevant or of insufficient quality. The remaining paper is shown in table 7.

Table 7

Comments

There is no evidence of the effect in patients with cervical spinal injuries. Furthermore, goniometric techniques do not assess the movement at an individual vertebral level.

Clinical bottom line

Cervical collars are of no additional benefit to patients already immobilised using a long spine board with straps.

Report by John Butler, Specialist Registrar Search checked by , Damien Bates, Specialist Registrar

References

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