Cervical Collars are Insufficient for Immobilizing an Unstable Cervical Spine Injury

Abstract

Background Cervical orthoses are commonly used for extrication, transportation, and definitive immobilization for cervical trauma patients. Various designs have been tested frequently in young, healthy individuals. To date, no one has reported the effectiveness of collar immobilization in the presence of an unstable mid-cervical spine. Study Objectives To determine the extent to which cervical orthoses immobilize the cervical spine in a cadaveric model with and without a spinal instability. Methods This study used a repeated-measures design to quantify motion on multiple axes. Five lightly embalmed cadavers with no history of cervical pathology were used. An electromagnetic motion-tracking system captured segmental motion at C5–C6 while the spine was maneuvered through the range of motion in each plane. Testing was carried out in intact conditions after a global instability was created at C5–C6. Three collar conditions were tested: a one-piece extraction collar (Ambu Inc., Linthicum, MD), a two-piece collar (Aspen Sierra, Aspen Medical Products, Irvine, CA), and no collar. Gardner-Wells tongs were affixed to the skull and used to apply motion in flexion-extension, lateral bending, and rotation. Statistical analysis was carried out to evaluate the conditions: collar use by instability (3 × 2). Results Neither the one- nor the two-piece collar was effective at significantly reducing segmental motion in the stable or unstable condition. There was dramatically more motion in the unstable state, as would be expected. Conclusion Although using a cervical collar is better than no immobilization, collars do not effectively reduce motion in an unstable cervical spine cadaver model. Further study is needed to develop other immobilization techniques that will adequately immobilize an injured, unstable cervical spine.