Neck movement in spite of collar

A cadaveric study using an artificially created unstable cervical spine injury has shown marked displacement of the vertebrae when cervical collars were applied, and when the bodies were moved in a way that simulated normal transfer and log-rolling. There was no comparison with a no-collar situation, so we can’t say from this that collars are necessarily bad, just that they’re no good in this cadaveric model. I like this statement by the authors:

A variety of collars, backboards, and other equipment and techniques are being used in an attempt to achieve spine stabilization, largely without any validation of efficacy when used in the presence of a severe cervical injury. Randomized, prospective clinical trial designs are challenging in this domain theless, basic cadaver studies can provide valuable insight into potential clinical efficacy.

"Severe unstable injuries were created in seven fresh whole human cadavers"

Even more musical to my ears is the editorial commentary by neurosurgery professor Richard L. Saunders, MD:

…the more compelling question is whether there is a place for collars in emergent protection of the injured cervical spine or are they simply a gimcrack***?
The incidence of second injuries to the spinal cord in the extraction of accident victims under the best of EMT performance is not known and would be difficult to determine. However, in an effort to minimize that incidence, paramedical gospel is the application of a cervical collar, maintaining the neck in in-line and in a neutral position. By definition, this gospel implies the deliberate movement of the neck to apply an orthotic known to be nonprotective. Furthermore, the neutral and in-line admonition implies that the patient’s neck position can be safely adjusted to “look better” without a shred of evidence that this might be a safer strategy than avoiding any unnecessary neck movement whatsoever….
…In a conclusion common to many small study reports, the authors recommend that more work should be done in this area. In my opinion that might be best in refinements of extraction methods with an eye to only that neck movement necessary to resuscitation, collar be damned.

Motion Within the Unstable Cervical Spine During Patient Maneuvering: The Neck Pivot-Shift Phenomenon
J Trauma. 2011 Jan;70(1):247-50

*** I confess never to have encountered this word before. According to the, a gimcrack is ‘A cheap and showy object of little or no use; a gewgaw‘. Now, WTF is a gewgaw?!?!

3 thoughts on “Neck movement in spite of collar”

  1. i’m sure you looked it up already, i had to…

    A Gewgaw = A showy trifle; a trinket; a bauble.

  2. HI Cliff and Chris

    Great article to cite. As an EMST/ATLS instructor I have to toe the party line on this when on courses but must admit of my declining faith in this area of trauma practice

    I had a Careflight colleague present this week on a plane crash primary retrieval she did in which one of the injured had a Le Fort III injury that looked awful. QUite correctly she chose not to practice religious EMST principles and did not place a neck collar in view of the potential worsening of his airway.

    I view this topic like cricoid pressure. SOmething that was handed down to us by our forbears as an article of faith. Like steroids in SCI I am sure if one day a proper study was done of techniques like cricoid pressure and neck collars we will all be looking very sheepish. IN fact Levitan has done a RCT in his ED setting on for that one when it gets published!

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