Collar Immobilization Research Articles

Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy

The objective of this systematic review was to use evidence-based medicine to identify the indications and utility of anterior cervical nerve root decompression. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to surgical management of cervical radiculopathy. Abstracts were reviewed after which studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations that contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Anterior nerve root decompression via anterior cervical discectomy (ACD) with or without fusion for radiculopathy is associated with rapid relief (3-4 months) of arm/neck pain, weakness, and/or sensory loss compared with physical therapy (PT) or cervical collar immobilization. Anterior cervical discectomy and ACD with fusion (ACDF) are associated with longer term (12 months) improvement in certain motor functions compared to PT. Other rapid gains observed after anterior decompression (diminished pain, improved sensation, and improved strength in certain muscle groups) are also maintained over the course of 12 months. However, comparable clinical improvements with PT or cervical immobilization therapy are also present in these clinical modalities (Class I). Conflicting evidence exists as to the efficacy of anterior cervical foraminotomy with reported success rates of 52-99% but recurrent symptoms as high as 30% (Class III). Anterior cervical discectomy, ACDF, and anterior cervical foraminotomy may improve cervical radicular symptoms. With regard to ACD and ACDF compared to PT or cervical immobilization, more rapid relief (within 3-4 months) may be seen with ACD or ACDF with maintenance of gains over the course of 12 months (Class I). Anterior cervical foraminotomy is associated with improvement in clinical function but the quality of data are weaker (Class III), and there is a wide range of efficacy (52-99%).

Backslab Versus Nonbackslab for Immobilization of Undisplaced Supracondylar Fractures

Immobilization of supracondylar fractures of the humerus, for 1 to 4 weeks in a backslab or a collar and cuff, produces good functional outcomes. This study assesses the pain associated with these 2 forms of immobilization. A randomized controlled trial comparing above-elbow posterior fiberglass slab and broad arm sling, with collar and cuff immobilization without plaster slab, was conducted at a children's hospital emergency department. Patients presenting with undisplaced supracondylar fractures were enrolled and reviewed after 2 weeks of immobilization. A daily diary was used during immobilization to assess pain, resumption of normal activity of the child, and parental satisfaction. Pain was assessed using a 100-mm visual analog scale. Fifty patients were enrolled, of whom 27 were randomized to a slab and 23 were randomized to a collar and cuff. Immobilization in a slab was associated with a reduction in time to resumption of normal activity, while immobilized in the device, with a median of 2.0 days (interquartile range [IQR], 1.0-5.0 days) versus 7.0 days (IQR, 3.0-13.0 days; P = 0.01). For the slab group, the median duration of pain was 4.0 days (IQR, 1-8.0 days) versus 6.0 days (IQR, 5.0-9.5 days) for the collar and cuff group (P = 0.07). Median daily pain severity was 28 mm for the slab group versus 33 mm for the collar and cuff group (P = 0.21). Moreover, 96% of parents in the slab group and 83% in the collar and cuff group would use the immobilization again (P = 0.17). For supracondylar fractures, use of an above-elbow posterior slab produces shorter duration of pain and reduces the time taken to become active again.

167. Odontoid Fractures in the Elderly: A Retrospective View of Complications and Outcomes

BACKGROUND CONTEXT: Odontoid fractures are particularly difficult to treat in the elderly. While recommendations range from collar immobilization to surgical fusion, few studies have examined outcomes in the elderly population.

Comparison between collar and cuffs and above elbow back slabs in the initial treatment of Gartland type I supracondylar humerus fractures

We compared two commonly used methods of immobilization of Gartland type I supracondylar humeral fractures, with respect to pain control, use of analgesia and sleep interruption. Forty patients were included in the study, collar and cuff immobilization (group 1, n=20) and above elbow back slab immobilization (group 2, n=20). Diagnosis was made in the accident department and patients were immobilized (collar and cuff or back slab) according to the preference of the treating doctor. Patients were then reviewed in the next available fracture clinic where they were assessed. The Wong-Baker faces scale was used to measure pain. Patients immobilized with a collar and cuff had an average pain score of 7.2 compared with 3.4 for those immobilized with a back slab (P<0.0001). Children in the collar and cuff group used analgesia at regular intervals nearly four times more often than those in the back slab group (P=0.005), and 85% of children immobilized with a collar and cuff had interrupted or no sleep throughout the night following the injury (P=0.008) compared with 45% of children in the back slab group. We conclude that immobilization of Gartland type I fractures with an above elbow back slab provides better pain relief and is more comfortable for paediatric patients than collar and cuff immobilization.

Morphological Adaptation of the Bone Graft and Fused Bodies after Non-Instrumented Anterior Interbody Fusion of the Lower Cervical Spine

To assess the remodelling process of the bone graft and fused bodies after non-instrumented anterior interbody fusion with autogenous iliac graft in patients with spondylosis, infections, fractures, or disorders of the cervical spine. 68 patients aged 18 to 58 years who underwent non-plated anterior lower cervical interbody fusion with an iliac graft were retrospectively studied. Diagnoses of the patients were degenerative disc diseases (n=32), disc herniation (n=15), fractures (n=13), and tuberculosis (n=8). The Robinson and Smith technique was used to treat degenerative disc diseases and protruded disc, and the Bailey and Badgley procedure for fractures or tuberculosis of the cervical spine. 34, 25, and 9 patients underwent one-, 2-, and 3-segment fusions, respectively. 18 of the 25 patients underwent two-segment fusion with a single large bone block, and 7 with 2 separate bone blocks for each segment. Four of the 9 patients underwent three-segment fusion with a single large bone block, and 5 used separate grafts for each segment independently. Plain and stress radiography was primarily used to assess the fusion. Computed tomography and magnetic resonance imaging were also used in some patients. Some anterior graft extrusion (amounting to less than 10% of corresponding anteroposterior body width) was used to observe the remodelling during graft-take and thereafter. Postoperative cervical traction for 2 to 4 weeks, then cervical collar immobilisation for 4 to 12 weeks were strictly followed according to the numbers of fused segments. A halo vest was applied in 4 patients with fracture undergoing 3-segment fusion as they could not tolerate the prolonged bed rest or rigid cervical brace. The mean time for the graft to fuse was 8.6 (range, 7-14) weeks in patients who underwent each segment fusion with independent free grafts, and 10 and 14 weeks in those who underwent 2- and 3-segment single large graft fusion, respectively. The final loss of disc height and joint angle were negligible, regardless of the extent of fusion. Bony absorption of the anteriorly protruded part of the graft began at postoperative week 10 (range, 6-28), which coincided with the time of graft-take and initiation of remodelling. The earliest sign of bony absorption of the anteriorly protruded part of the graft indicated the initiation of the graft-take and the graft remodelling. The inwaisting sign of the surgically fused block of vertebral bodies was a morphological adaptation. Despite the altered biomechanics of the spine in the fused area, the inwaisting sign indicated maintenance of normal function at the parafusion motion segments.

Management of Recalcitrant Osteoarthritis of the Atlanto-Axial Joint

The medical records and radiographs of 17 patients with recalcitrant pain secondary to C1-C2 osteoarthritis were independently reviewed. All patients were treated by the senior author (K.D.R.). Initial treatment included physical therapy, nonsteroidal anti-inflammatory drugs, and soft collar immobilization. If non-responsive, patients were referred to a single radiologist for injection of the involved C1-C2 joint(s). If symptoms persisted, then transarticular screw fixation and Magerl wire fixation with structural iliac crest bone graft was performed. Postoperatively, all patients were placed in a soft collar. Postoperative anteroposterior (AP), lateral, flexion/extension, and open-mouthed odontoid radiographs were taken at 6 weeks, 3 months, and 1 year. Three independent observers assessed all radiographs for fusion. Fusion was noted by radiographic evidence of bridging bony trabeculae across the C1-C2 joint and/or bridging bone from the posterior arch of C1 to the C2 spinous process. Patient satisfaction improved significantly whether they were treated by corticosteroid injection or surgically.

Prise en charge des fractures supracondyliennes en extension stade IV de Lagrange et Rigault

Purpose of the study Lagrange and Rigault stage IV extension type supracondylar fracture of the humerus (Gartland and Wilkins type III) involves major displacement, making treatment difficult. Several therapeutic methods have been described but indications vary considerably between teams. We conducted a retrospective analysis in order to evaluate the results of different methods, identify the most adapted technique, and detail the conditions necessary for good results with the collar and cuff immobilization method described by Blount. Material and methods Forty-four children (30 boys and 14 girls), mean age seven years six months, were treated between January 1990 and December 2001. The collar and cuff immobilization technique was used for sixteen children (including four who underwent open revision for early secondary displacement), percutaneous pinning for two, and open crossed pinning for thirty (including four who developed secondary displacement after collar and cuff immobilization). One out of two collar and cuff treatments was instituted within six hours of injury. The four secondary displacements after collar and cuff immobilization treatment occurred after fracture reduction more than six hours after injury. The proportion of open reductions increased with longer delay to reduction after injury. Mean immobilization was three and a half weeks. The Flynn criteria were used to assess outcome at mean seven years eight months follow-up. Results Outcome was satisfactory in all children treated with definitive collar and cuff immobilization and by percutaneous pinning; the rate was 97% after open procedures (persistent sequelae of radial palsy in one child). Discussion Early treatment before six hours increased the chances of success with the collar and cuff method which remains the technique of choice for Lagrange and Rigault stage IV extension type supracondylar fractures. In the event of failure or complications, other classical methods should be discussed, including percutaneous pinning or direct access for open osteosynthesis.

Effect of hair and clothing on neck immobilization using a cervical collar

An important step during spine immobilization is application of a cervical collar. Clothing or hair covering the neck may impinge on this process. The purpose of this study was to evaluate the effect of clothing and hair covering the neck on immobilization using a cervical collar. Study participants were 18 female volunteers with long hair aged 20 to 28 years. Cervical range of motion (ROM) was tested in 6 directions (flexion, extension, right and left lateral bending, right and left axial rotation) using a cervical ROM (CROM) device. After measuring unrestricted ROM (no cervical collar), a 1-piece rigid cervical collar was placed the neck (1) covered by hair and clothing; (2) covered by clothing; (3) covered by hair; or (4) uncovered. Range of motion was retested under all 4 conditions. Data were compared using crossover-design analysis of variance ( P < .05 statistically significant). Range of motion in all directions was significantly restricted by cervical collar placement under all conditions. Unrestricted ROM in all directions ranged from 41.50° (7.25°) to 70.76° (15.4°). In contrast, ROM with a cervical collar under the 4 conditions in all directions ranged from 10.80° (5.10°) to 18.81° (7.37°). We were unable to detect any significant differences in ROM between the 4 conditions. Our data suggest that long hair and clothing, which cover the neck, do not alter the effectiveness of cervical collar immobilization as measured by the cervical ROM device.

Tête tombante fixée : efficacité d'une rééducation intensive

Objectives. – To point out the diagnostic and etiologic context of neck extensor weakness and to consider orthopedic and rehabilitation treatment of dropped head syndrome. Methods. – We report a case of a 68-year-old hospitalized woman with atypical and serious idiopathic neck extensor weakness who was treated by orthopedic measurements and intensive rehabilitation. Results. – Our patient had progressive neck extensor weakness and total inflection of the cervico-cephalic axis over two years. Fixed and permanent contact of the chin and the sternum severely affected her ability to eat, and mandibular and sternal pressure ulcers developed. Cervical spine radiography revealed degenerative lesions. Other clinical and biological parameters were normal. Atypical idiopathic head drop was diagnosed because of painful and fixed head position. Rehabilitation consisted of cervical traction with a halo apparatus during eight weeks and an exercise programme based on cervical proprioception and muscular work. Orthopedic management consisted of cervical collar immobilization after cutaneous cicatrization. After ten weeks of treatment, the patient was able to raise her head and maintain it horizontally. Two years later, clinical results were stable. Discussion. – Neck extensor weakness may be the presenting feature of several neuromuscular disorders. Generally, idiopathic dropped head syndrome appears to be the most likely diagnosis in patients with isolated neck extensor involvement. For our patient, clinical findings and cervical computed tomography showed important muscular weakness. However, painful passive extension and progressive stiffness of the neck do not represent the typical clinical course of idiopathic head drop. Neither degenerative lesions of the cervical spine nor other joint diseases can cause head drop. This case may result from the combined effects of idiopathic dropped head syndrome and cervical arthrosis. Orthopedic treatment and intensive rehabilitation had spectacular effects. Clinical management of head drop syndrome should always consist of orthopedic and rehabilitation treatment.

Cochrane Review on the Role of Surgery in Cervical Spondylotic Radiculomyelopathy

This study involved a search of MEDLINE (1966 to 2000), EMBASE (1980 to 2000), and the Cochrane Controlled Trials Register. The authors of the identified randomized controlled trials were contacted to detect any additional published or unpublished data. The trials selected for this study included all the truly unconfounded or quasi-randomized controlled investigations allocating patients with cervical radiculopathy or myelopathy to 1) "best medical management" or "decompressive surgery (with or without some form of fusion) plus best medical management," or 2) "early decompressive surgery" or "delayed decompressive surgery." Two reviewers independently selected trials for inclusion, assessed trial quality, and extracted the data. To determine whether surgical treatment of cervical radiculopathy or myelopathy is associated with improved outcome, as compared with conservative management, and whether the timing of surgery (immediate or delayed because of persistence or progression of relevant symptoms and signs) has an impact on outcome. Cervical spondylosis causes pain and disability by compressing the spinal cord or roots. Surgery to relieve the compression may reduce the pain and disability. However, it is associated with a small but definite risk. This study sought to assess the balance of risk and benefit from surgery. Two trials involving a total of 130 patients were included. One trial with 81 patients compared surgical decompression with either physiotherapy or cervical collar immobilization in patients with cervical radiculopathy. The short-term effects of surgery, in terms of pain, weakness, or sensory loss were superior. However, at 1 year no significant differences between the groups were observed. Another trial with 49 patients compared the effects of surgery with those of conservative treatment in patients who had a mild functional deficit associated with cervical myelopathy. No significant differences were observed between the groups up to 2 years after treatment. The data from the reviewed trials were inadequate to provide reliable conclusions on the balance of risk and benefit from cervical spine surgery for spondylotic radiculopathy or myelopathy.

Surgery for cervical radiculomyelopathy.

Cervical spondylosis causes pain and disability by compressing the spinal cord or roots. Surgery to relieve the compression may reduce the pain and disability, but is associated with a small but definite risk. We sought to assess the balance of risk and benefit from surgery. To determine whether: 1) surgical treatment of cervical radiculopathy or myelopathy is associated with improved outcome, compared with conservative management and 2) timing of surgery (immediate or delayed upon persistence/progression of relevant symptoms and signs) has an impact on outcome. We searched Medline (between 1966 and 1998), Embase (between 1980 and 1998) and the Cochrane Controlled Trials Register. Authors of the identified randomised controlled trials were contacted to detect any additional published or unpublished data. All unconfounded truly or quasi-randomised controlled trials allocating patients with cervical radiculopathy or myelopathy to 1) "best medical management" or "decompressive surgery (with or without some form of fusion) plus best medical management" 2) "early decompressive surgery" or "delayed decompressive surgery". Two reviewers independently selected trials for inclusion, assessed trial quality and extracted the data. Two trials involving a total of 130 patients were included. One trial with 81 patients compared surgical decompression with either physiotherapy or cervical collar immobilization in patients with cervical radiculopathy. The short-term effects of surgery, in terms of pain, weakness or sensory loss were superior, however, at one year no significant differences between groups were present. One trial with 49 patients compared the effects of surgery with those of conservative treatment in patients with mild functional deficit associated with cervical myelopathy. No significant differences were observed between groups, up to two years following treatment.

Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation

Study Objective: Orotracheal intubation (OTI) is commonly used to establish a definitive airway in major trauma victims, with several different cervical spine immobilization techniques and laryngoscope blade types used. This experimental, randomized, crossover trial evaluated the effects of manual in-line stabilization and cervical collar immobilization and 3 different laryngoscope blades on cervical spine movement during OTI in a cadaver model of cervical spine injury. Methods: A complete C5-C6 transection was performed by using an osteotome on 14 fresh-frozen cadavers. OTI was performed in a randomized crossover fashion by using both immobilization techniques and each of 3 laryngoscope blades: the Miller straight blade, the Macintosh curved blade, and the Corazelli-London-McCoy hinged blade. Intubations were recorded in real time on fluoroscopy and then transferred to video and color still images. Outcome measures included movement across C5-C6 with regard to angulation expressed in degrees of rotation and axial distraction and anteroposterior displacement with values expressed as a proportion of C5 body width. Cormack-Lehane visualization grades were also recorded as a secondary outcome measure. Data were analyzed by using multivariate analysis of variance to test for differences between immobilization techniques and between laryngoscope blades and to detect for interactions. Significance was assumed for P values of less than.05. Results: Manual in-line stabilization resulted in significantly less movement than cervical collar immobilization during OTI with regard to anteroposterior displacement. Use of the Miller straight blade resulted in significantly less movement than each of the other 2 blades with regard to axial distraction. The Cormack-Lehane grade was significantly better with manual in-line stabilization versus cervical collar immobilization; no differences were observed between blades. Conclusion: Manual in-line stabilization results in less cervical subluxation and allows better vocal cord visualization during OTI in a cadaver model of cervical spine injury. The Miller laryngoscope blade allowed less axial distraction than the Macintosh or Corzelli-London-McCoy blades. The clinical significance of this degree of movement is unclear. [Gerling MC, Davis DP, Hamilton RS, Morris GF, Vilke GM, Garfin SR, Hayden SR. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Ann Emerg Med. October 2000;36:293-300.]

Evaluation of the role of pin fixation versus collar and cuff immobilisation in supracondylar fractures of the humerus in children

Long term results of children with supracondylar humeral fractures treated with manipulation and strapping and manipulation followed by pin fixation were evaluated. Forty patients were regarded as Gartland type II injuries. 33 of these were treated with closed reduction and collar and cuff immobilisation and 7 with closed reduction and percutaneous pinning. Two cases of cubitus varus were reported one from each treatment modality Forty-four patients were included as Gartland type III injuries. Of these 14 were treated with closed reduction and collar and cuff immobilisation, 25 with closed reduction and percutaneous pinning and five with open reduction and pinning. There were two cases of cubitus varus and one case of cubitus valgus following pin fixation. In addition one case of extension lag and one significant ulnar nerve neurapraxia was recorded following pin fixation. One case of cubitus varus was seen following manipulation and collar and cuff treatment. There was no statistical difference between either treatment modality in terms of predicting a better outcome ( p>0.05). We conclude that pin fixation has no advantages over simple immobilisation in certain Gartland II and III type injuries. Although pin fixation is beneficial in unstable injuries collar and cuff immobilisation continues to have an important role in the treatment of stable supracondylar fractures.

Complex atlantoaxial fractures.

The authors conducted a retrospective study to evaluate the treatment of complex C1-2 fractures. There were 10 cases of complex C1-2 fractures. Six patients were men (median age 58 years) and four patients were women (median age 55.5 years). Injuries resulted from seven falls, two motor vehicle accidents, and one diving incident. Three patients suffered from upper-extremity weakness. Neurological function in seven patients was intact preoperatively. Fracture combinations included six Jefferson/Type II odontoid, two anterior ring/Type II odontoid, one posterior ring/Type II odontoid, and one posterior ring/Type III odontoid/Type III hangman's fracture. All patients underwent surgery, five after halo immobilization for an average of 4 months failed to provide stability. Treatment included placement of six odontoid screws, one posterior C1-2 transarticular screw, one odontoid screw with anterior C1-2 transarticular screw fixation, one C1-2 transarticular screw with C1-2 Songer cable fusion, and one odontoid screw with bilateral C-2 pedicle screw fixation. Specific treatment was determined by the combination of fractures. Postoperatively, all patients were immobilized in a hard collar for 3 months. There were no intraoperative surgery-related complications. The mean follow-up period was 28.5 months. Neurological recovery was observed in one of three patients who presented with neurological deficits. Fusion occurred in all cases. The goals in treating these complex fractures are to achieve early maximum stability and minimum reduction in range of motion. These are often competing phenomena. Frequently in cases of atlas-axis fracture, odontoid screw fixation combined with hard collar immobilization is the best therapy, provided the transverse atlantal ligament is competent. If not, C1-2 stabilization with placement of transarticular screws is required for best results.

Current management of pediatric atlantoaxial rotatory subluxation.

A retrospective clinical review of 20 children seen during a 7-year period who had atlantoaxial rotatory subluxation. To define the effectiveness of imaging and treatment measures and to identify risk factors for recurrence, the series was reviewed to analyze cause, management, and outcome. Rotatory subluxation of the atlantoaxial complex remains a poorly understood entity. Despite many reports in the literature, there is no consensus about which imaging studies should be used for diagnosis and which patients benefit from collar immobilization, traction, or surgical fusion. Between August 1990 and April 1997, 20 children with atlantoaxial rotatory subluxation were treated. Fourteen patients (70%) were girls and six (30%) were boys (mean age, 6.4 years). All patients had torticollis and neck pain with decreased cervical motion for a mean of 11.2 days before diagnosis. Seven patients (35%) had a history of pharyngitis or otitis media, four (20%) had recently undergone head or neck surgery, and four (20%) had sustained a traumatic injury; in five patients (25%), no clear cause was determined. All patients were neurologically intact and underwent plain cervical radiographs and dynamic cervical computed tomography to document atlantoaxial rotatory subluxation. Patients were then treated with a rigid cervical collar and anti-inflammatory agents (n = 5) or with cervical traction followed by immobilization (n = 15). In four of the five patients in collars, reduction occurred spontaneously, whereas the fifth required cervical traction and eventual fusion for recurrence. In the 16 patients treated with traction (median, 1.8 kg), the normal atlantoaxial alignment was restored in 15 patients (94%) within a mean of 4 days. Of the 20 patients treated overall, conservative management failed in 6 (30%), and they required posterior fusion because of recurrence of the atlantoaxial rotatory subluxation or unsuccessful reduction. The major factor predicting the failure of conservative management was the duration of subluxation before initial reduction. Patients with long-standing subluxation were more likely to experience recurrence and require surgery. There were no complications noted. At follow-up, all patients who were treated conservatively remained neurologically intact with a normal atlantoaxial relation. All patients who underwent surgery remained neurologically intact and had radiographic documentation of fusion. Optimal management of atlantoaxial rotatory subluxation entails early diagnosis with plain cervical radiographs and dynamic computed tomography. Closed reduction with cervical traction followed by rigid immobilization accomplished reduction in 15 of 16 patients (94%) and was curative in 10 of 16 patients (63%). Although reduction was achieved more rapidly and effectively with traction than with a collar, there may be a role for simple immobilization without reduction in patients with a short duration of symptoms. There does not appear to be a correlation between cause of atlantoaxial rotatory subluxation, age, or sex and the likelihood of recurrence.

Axillary node clearance: who wants to immobilize the shoulder?

Sixty-seven patients undergoing level three axillary node clearance were studied to ascertain the benefit of collar and cuff shoulder immobilization in reducing the incidence of axillary seroma formation. During this period the patients' views were obtained on this aspect of post-operative care. Although daily drainage volume decreased more rapidly in those patients whose shoulders were immobilized this did not result in a significant decrease in seroma formation following drain removal on the fifth post-operative day (31% vs 43%, P>0.05). Patient interviews revealed that they found the collar and cuff incapacitating, felt it delayed their return to normal activity and made personal hygiene difficult to maintain. In view of these results shoulder immobilization should not be employed in the routine post-operative care of these patients.

The impact of a cervical spine radiographic protocol on cost and prophylactic spinal immobilization

84 The Impact of a Cervical Spine Radiographic Protocol on Cost and Prophylactic Spinal Immobilization SGA Gabram, RJ Schwartz, LM Jacobs/Hartford Hospital, University of Connecticut School of Medicine, Hartford A prospective cohort study was conducted to determine the impact of a protocol for the radiographic evaluation of the cervical spine of blunt-injured patients. All admitted blunt trauma patients with suspected injury to the cervical spine were entered into the study. Data on patients were collected two months prior (75) and two months after protocol (68). The protocol eliminated routine oblique views and instituted earlier computed tomography (CT) scanning of the odontoid if open-mouth Water's views were unobtainable. Data elements included age, mechanism of injury, Injury Severity Score (ISS), Glasgow Coma Scale (GCS), number of days of spinal collar immobilization, diagnoses related to cervical spine injuries, radiograph-related charges, and initial physical examination results. The two groups were not statistically different in age, GCS, ISS, and number intubated. Three patients in the preprotocol group had confirmed (CT scan) spinal injuries; there were none in the after protocol group. The range of days patients were immobilized was one to 11 (mean, t.87) for the prior group and one to four (mean, 1.2) for the after group (P = .003). For those patients whose initial physical and radiographic examinations were suggestive of an injury, the number of days for cervical collar immobilization decreased from 5.2 days in the prior group to 1.8 days in the after group (P = .01). Intubated patients decreased from 4.1 days to 1.6 days (P = .009). Cervical spine-related radiograph charges decreased from $8,782 (mean, $117) to $6,679 (mean, $98) (P = .079). The use of a predetermined protocol for evaluating the cervical spine in blunt trauma can decrease the number of days of cervical spine immobilization and decrease radiograph-related charges.

Injuries of the Atlas and Axis

In a follow-up study of ten atlas and 85 axis fractures, 12% had residual symptoms in the form of local and radiating cervical pain. The residual symptoms were interpreted as a sign of a mild demyelinating process initiated by the trauma of the medulla. At least 22% of the accidents occurred while the person was under the influence of drugs or alcohol. Therefore, a wide range of residual symptoms (progressive or nonprogressive) could be attributed in part to abuse of drugs and alcohol. A permanent measurable loss of motion occurred following injury to the atlas or axis, irrespective of the modality of treatment. Cervical fusion created the greatest loss of motion and collar immobilization the least. Skull traction and a halo-vest were intermediate in patients with loss of motion, and the degree of loss of range was essentially equal. Residual symptoms, including pain, were found in 20% of those treated with a collar, 40% of those treated with surgical methods, 5% of those treated with traction, and 5% of those treated with a Halo-vest. Residual symptoms did not correlate at all with degree of displacement of the original fracture.

Myelopathy due to cervical spondylosis treated by collar immobilization

Myelopathy due to cervical spondylosis treated by collar immobilization