Semi-rigid Cervical Collar Research Articles

The clay-shoveler’s fracture, a rare occupational injury in the modern era: a case report

BackgroundThe clay-shoveler fracture, named after Australian clay shovelers from the 1930s, results from high-energy, repetitive pulling mechanisms and is commonly associated with shoveling or digging. This injury primarily affects the lower cervical and upper thoracic vertebrae, particularly the C7 and T1 vertebrae. The avulsion mechanism, caused by stress on the spinous processes, may lead to sudden, severe upper back pain, limiting the affected individual’s ability to work effectively.Case presentationThis report presents the case of a 27-year-old boiler operator who experienced persistent neck pain, which did not respond to conservative management. Imaging studies revealed a T1 spinous process fracture with associated soft tissue edema, diagnosed as a clay-shoveler fracture. Conventional treatment with a semirigid cervical collar, analgesia, and rest was administered, leading to a favorable outcome.The clay-shoveler fracture, though rare, should be considered in cases involving repetitive stress on the cervical and thoracic spine, especially in occupations that require heavy lifting. In most instances, conservative management proves effective in relieving pain and enabling recovery.ConclusionRecognizing the clay-shoveler fracture is crucial for timely diagnosis and treatment. This case report underscores the occupational nature of the injury and its association with specific work activities. Further research and reporting of similar cases will contribute to a deeper understanding of this unusual fracture pattern, its risk factors, and optimal management strategies.

Effects of 20-degree spinal immobilization on respiratory functions in otherwise healthy volunteers with android-type obesity

AimThe aim of the study was to assess whether spinal immobilization with long back board (LBB) and semi-rigid cervical collar (CC) at 20° instead of 0° conserves pulmonary functions in obese volunteers, including forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. MethodsThe study included adult volunteer subjects with android-type obesity who were otherwise healthy. First, pulmonary functions were tested in a seated position to obtain baseline levels, than volunteers were immobilized with LBB and CC at 0-degree and measurements repeated at 0th and 30th minute of immobilization. Next day, same procedures were repeated with the trauma board at 20-degree. Changes over time in FEV1, FVC values and FEV1/FVC ratios during spinal immobilization at 0° and 20° were compared to baseline levels. ResultsStudy included 30 volunteers. Results showed a significant decline in all values for both situations following spinal immobilization (p < .001). We also compared the decrease over time in those values (ΔFEV1, ΔFVC, and ΔFEV1/FVC ratio) during spinal immobilization at 0° and 20°. The decrease in pulmonary functions was similar in both groups (p > .05). ConclusionThe present findings confirm that spinal immobilization reduces pulmonary functions in obese volunteers, and that 20-degree immobilization has no conservative effect on these values when compared to the traditional 0-degree immobilization. It may be that 20° is insufficient to decrease the negative effect of abdominal obesity on pulmonary functions.

Open-design collar vs. Conventional Philadelphia collar regarding user satisfaction and cervical range of motion in asymptomatic adults

Cervical collars are often prescribed to minimize physiologic loads and movements between the head and thorax by limiting cervical motion; they are also used for supporting a patient's head and reducing the risk of cervical injury resulting from additional spinal movements. One of the problems in orthotic treatment is the unpleasant appearance of the orthosis, which could impede the patient from continuing treatment. Currently, it is essential to consider the importance of the psychologic effect of rehabilitative treatment. The current study aimed to compare the Philadelphia collar and an open-design cervical collar with regard to user satisfaction and cervical range of motion in asymptomatic adults. Seventy-two healthy subjects (36 women, 36 men) aged 18 to 29 years were recruited for this study. Neck movements, including active flexion, extension, right/left lateral flexion, and right/left axial rotation, were assessed in each subject under 3 conditions—without wearing a collar and while wearing 2 different cervical collars—using a dual digital inclinometer. Subject satisfaction was assessed using a 5-item self-administered questionnaire. Both Philadelphia and open-design collars significantly reduced cervical motions ( P < 0.05). Compared with the Philadelphia collar, the open-design collar more greatly reduced cervical motions in three planes and the differences were statistically significant expects for limiting flexion. Satisfaction scores for Philadelphia and open-design collars were 15.89 ± 3.87 and 19.94 ± 3.11, respectively. This study demonstrated that the open-design collar is more cosmetically acceptable as a semirigid cervical collar compared with the Philadelphia collar, at least for subjects aged under forty years, while it also has optimal restriction potential. Further studies are needed to investigate its effectiveness in restricting cervical intervertebral motion and long-term compliance.

The effectiveness of soft and semi-rigid cervical collars on acute cervical radiculopathy

Objectives. Cervical radiculopathy is one of the common causes of the neck pain. Medical devices in the form of cervical collars are frequently recommended in acute cervical radiculopathy. We aim to investigate and compare the effect of soft and semi-rigid cervical collars on neck pain, disability and daily life activities in the patients with acute cervical radiculopathy. Methods. We designed a prospective, single-blind, randomized controlled study. This study was conducted on 101 patients who were diagnosed with clinical features of radiculopathy and imaging showing cervical disc herniation. Visual Analog Scale (VAS), Neck Disability Index (NDI) and SF-36 were applied to the subjects. Evaluation of the patients was done before the treatment and 2 weeks and 6 weeks after the start of the treatment. Patients were divided into three groups according to the computer-generated randomization table: Soft cervical collar, semi-rigid cervical collar and control group. The patients in collar groups were asked to wear the collars for 8 hours during the day for the first 2 weeks. Results. Comparison of the soft cervical collar group with the control group showed significantly better improvement in the former in VAS and NDI scores at week 2 and 6 ( p < 0.05), in SF-36 pain perception subunit at week 2 ( p < 0.05), and in SF-36 physical component score at week 6 ( p < 0.05). Comparison of the semi-rigid cervical collar group with the control showed significantly better improvement in the former for NDI scores and SF-36 pain perception subunit at week 2 and 6 ( p < 0.05). Conclusions . The results of our study have indicated that the use of soft and semi-rigid cervical collars was more effective than conservative treatment in treatment of neck pain and disability in acute cervical radiculopathy in the short term. Soft cervical collars were also found to be more effective for pain management than semi-rigid cervical collars.

Evaluation of the Intubating Laryngeal Mask Airway (ILMA) as an intubation conduit in patients with a cervical collar simulating fixed cervical spine

Background: Cervical spine immobilisation with a semi-rigid cervical collar imposes difficulty in tracheal intubation. There is increasing use of the Intubating Laryngeal Mask Airway (LMA- FastrachTM) for intubation in patients with difficult airways. The present study was conducted to assess its potential role for tracheal intubation in simulated fixed cervical spine patients.Method: After obtaining approval from the ethics committee and patients’ consent, this observational study was performed on 35 adult patients of either sex of ASA physical status I and II scheduled to undergo surgery under general anaesthesia requiring tracheal intubation. A two-piece semi-rigid cervical collar of appropriate size was positioned around the neck of patients. A standard anaesthesia protocol comprising glycopyrrolate, propofol and vecuronium was used for induction of anaesthesia. ILMA placement and blind tracheal intubation through this was attempted by using dedicated silicone tube provided with the ILMA set. Success ...

Effects of spinal immobilization at 20° on respiratory functions

PurposeThe purpose of the study is to investigate whether spinal immobilization with a long backboard (LBB) and semirigid cervical collar (CC) at 20° instead of 0° conserve pulmonary functions, including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), and FEV1/FVC ratio. MethodologyThe study included 56 adult healthy volunteers. Volunteers were randomly divided into 2 groups, and those in the first group (group 1) had LBBs and CCs applied at 0° (n=30), whereas volunteers in the second group (group 2) had LBBs and CCs applied at 20° (n=26). All volunteers were given pulmonary function tests, which included FEV1 and FVC levels and FEV1/FVC ratios, while in the sitting position. Measurements were repeated at 0, 5, and 30 minutes. ResultsResults showed significant decreases in FEV1 and FVC values and FEV1/FVC ratios in group 1 and significant decreases in FEV1 values and FEV1/FVC ratios in group 2 (P<.001). However, FVC values were not decreased in group 2 when compared to basal levels taken while in a sitting position (P=.45). In addition, the study evaluated the amounts of decrease in the FEV1 and FVC levels and the FEV1/FVC ratios (ΔFEV1, ΔFVC, and ΔFEV1/FVC ratio). Results showed that ΔFEV1 values compared to basal levels and levels at 0, 5, and 30 minutes were all lower in group 2 than in group 1. However, ΔFEV1/FVC ratios were similar in both groups. ConclusionThe results of this and previous studies have shown that traditional spinal immobilization decreases respiratory function, whereas using spinal immobilization at 20° can reduce this decrease in function.

Lower Pole Release in Congenital Muscular Torticollis – Retrospective Analysis of Outcomes in 15 Cases

Abstract Congenital muscular torticollis is a common congenital problem. It is considered to be amenable to treatment which may be conservative or surgical. There are as yet no fixed guidelines as to the methodology or the timing of treatment. It is certainly advised to be prudent in selecting the appropriate treatment which should neither be too conservative nor over-invasive. We are reporting a series of 15 cases in which we did a unipolar release of the sternocleidomastoid muscle at the lower attachment. Retrospective analysis of 15 consecutive patients is done. During the postoperative period the parents were advised to regularly continue with the stretching exercises, focus on activities on the opposite side of the face and use a semi-rigid cervical collar, specially designed for active correction of these cases. We got very satisfactory postoperative results in most of our patients except one who had resistant deformity due to advanced age. In conclusion we would like to bring the focus back to unipolar release which is shifting unduly in favour of a bipolar release. This would also reduce the chances of the complication of accessory nerve injury. We have used the scoring system developed by Cheng et al and modifi ed by Shim in which the present cases showed improvement of 7 points with p-value of less than 0.0001

Traumatic Spondylolisthesis of the Axis Vertebra in Adults.

Study Design Narrative review. Objective To elucidate the current concepts in diagnosis and treatment of traumatic spondylolisthesis of the axis. Methods Literature review using PubMed, Google Scholar, and Cochrane databases. Results The traumatic spondylolisthesis of the axis accounts to 5% of all cervical spine injuries and is defined by a bilateral separation of the C2 vertebral body from the neural arch. The precise location of the fracture line may vary widely. For understanding the pathobiomechanics, the involvement of the C2–C3 disk is essential. Although its synonym “hangman's fracture” suggests an extension moment as primary injury mechanism, flexion moments are also proven to cause such fracture morphology. The axial force vector (distraction versus compression) is thought to have a significant effect on the neurologic involvement. The most widely accepted classifications, according to Effendi and modified by Levine, regard the displacement of the C2 vertebral body and possible locking of the facet joints. For decisions on conservative versus surgical therapy, a definitive statement about the stability is essential. The stability is determined by involvement of the C2–C3 disk and longitudinal ligaments, which frequently cannot be assessed by X-ray or computed tomography alone. The assessment of this soft tissue injury therefore requires additional imaging either by magnetic resonance imaging to display the disk and longitudinal ligaments or dynamic fluoroscopy to assess functional behavior of the C2–C3 motion segment. If stability is proven, an immobilization of the cervical spine in a semirigid cervical collar is sufficient. Unstable lesions require surgical stabilization. The standard procedure is an anterior C2–C3 diskectomy and fusion, because of the lower morbidity of the anterior approach and the motion preservation between C1 and C2. In rare cases (irreducible locked facet joints, the necessity of decompression of the vertebral artery, contraindication for anterior approach), a posterior approach is sometimes necessary. Isolated direct screw osteosynthesis is of little value, because it only makes sense in cases with an intact C2–C3 disk, which is usually regarded as stable and therefore might be treated conservatively. Conclusions Overall, the clinical evidence regarding traumatic spondylolisthesis of the axis is very low and mainly based on small case series, expert opinion, laboratory findings, and theoretical considerations.

The ‘Necksafe’ head articulation control system: a novel cervical immobilisation device

IntroductionThe early application of a semirigid disposable cervical collar following trauma is considered a routine practice. The aim of these devices is to immobilise the cervical spine and minimise the...

Die atlantoaxiale Dislokation

Injuries of the cervical spine in adolescents only occur in 0.2 % of cases. Due to the mismatch of size of the head in comparison to the relatively weakly developed neck muscles at this age, the cranial section is more vulnerable to injuries of any kind compared to the lower sections of the cervical spine. In children isolated ligament trauma is more common than fractures due to the relatively good bone structure combined with a lower bone density but the risk for fractures increases with the age of the patient. Atlantoaxial dislocation (AAD) in children is a very rare mostly ligamentous injury. A differentiation is made between traumatic AAD and the much more common non-traumatic AAD described in the literature. Although the cause is still unknown different risk factors have been isolated that seem to increase the risk for non-traumatic AAD. The following article presents guidelines for the diagnosis and treatment of this rare type of injury and also describes the case of a 19-year-old female who presented at the emergency department with an AAD without a history of trauma. After successful closed repositioning the neck was stabilized in a semi-rigid cervical collar for 6 weeks.

Design of Cervical Brace for Trauma Patients

Design of Cervical Brace for Trauma Patients

Stylet‐ or forceps‐guided tube exchanger to facilitate GlideScope® intubation in simulated difficult intubations – a randomised controlled trial

The GlideScope videolaryngoscope is widely used in the management of the difficult airway. However, passing the tracheal tube through the vocal cords can be awkward, and the use of a stylet to guide insertion is recommended. This randomised controlled trial evaluated a forceps-guided tube exchanger as an alternative to the stylet to aid intubation with the GlideScope in patients undergoing anaesthesia, with a simulated difficult airway created by the application of a semi-rigid cervical collar. Data were analysed from 178 patients randomly assigned to undergo intubation using either the stylet (n = 88) or a forceps-guided tube exchanger (n = 90). All intubations were completed successfully, with first attempt rates of 93.2% using the stylet and 94.4% using the exchanger (p = 0.597). The mean (SD) intubation time was 67.8 (28.7) s in the stylet group and 66.1 (15.5) s in the forceps-guided tube exchanger group (p = 0.11). The frequency of sore throat 1 h after extubation was 34.1% in the stylet group and 2.2% in the tube exchanger group (p < 0.001); 24 h after extubation the corresponding figures were 40.0% and 11.1% (p < 0.001). Using a forceps-guided tube exchanger may offer an advantage over a stylet in guiding tracheal intubation when the GlideScope is used.

Standard Flexible Fiberscope Superior to Ambu aScope 2

The Ambu aScope 2 is a new inexpensive, single-use, flexible video endoscope. To compare performance of the aScope 2 and a standard reusable fiberscope, researchers randomized 100 healthy adult elective surgery patients to intubation with either device by a single experienced anesthetist. A semirigid cervical collar was placed on all patients to simulate a difficult …

Why Do We Put Cervical Collars On Conscious Trauma Patients?

In this commentary we argue that fully alert, stable and co-operative trauma patients do not require the application of a semi-rigid cervical collar, even if they are suspected of underlying cervical spine fracture, unless their conscious level deteriorates or they find the short-term support of a cervical collar helpful. Despite the historical and cultural barriers that exist, the potential benefits are such that this hypothesis merits rigorous testing in well-designed research trials.

Left molar approach improves laryngeal view in patients with simulated limitation of cervical movements

Immobilized cervical spine, because of either diseases or stabilizing devices, poses considerable difficulties with endotracheal intubation due to poor laryngoscopic view. The left molar (LM) approach has been shown to be useful in difficult sporadic intubation cases. We evaluated efficacy of this approach of laryngoscopy to improve laryngeal view in patients with simulated limitation of cervical movements. Thirty patients of American Society of Anesthesiologists grade I/II, who were scheduled to undergo routine surgical procedures under general anaesthesia and endotracheal intubation, were studied. A two-piece semi-rigid cervical collar was used to immobilize the cervical spine. Under standardized anaesthesia and neuromuscular blocking agent, conventional laryngoscopy using a curved Macintosh blade was performed and glottic view was recorded with and without optimal external laryngeal manipulation (OELM). Subsequently, in the same subjects the laryngoscope blade was withdrawn and re-inserted through the LM approach and glottic view was recorded with and without OELM followed by tracheal intubation. With the conventional approach, laryngeal view was recorded as grade II in five patients, grade III in 24 patients, and grade IV in one patient. However, with the LM approach, laryngeal view was grade I in 25 patients, grade II in five patients, and grade III or IV in none (P<0.001). Tracheal intubation with the LM approach required the use of a flexible stylet to guide the tube tip into the larynx. The laryngeal view is improved by the LM approach in patients with simulated limited cervical movements with a high success rate of tracheal intubation, but requires orientation for negotiation of the tube through the narrow oropharyngeal space available.

Anterior Cervical Discectomy and Fusion Without Instrumentation

Review of clinical file information and postoperative imaging, collected prospectively over a period of 14 years, in anticipation of study. 1) Assessment of technical success in achieving anterior cervical fusion without internal fixation; 2) assessment of postoperative neck pain relevant to technical success or failure of fusion; and 3) assessment of morbidity arising from iliac crest bone graft donor site. After anterior cervical discectomy and bone grafting for cervical radiculopathy or the intractable pain of cervical spondylosis, common clinical practice varies widely between the extremes of internal fixation in all cases, and never applying fixation. The clinical information and relevant imaging of 97 consecutive patients, 46 male, was reviewed at 12 months after surgery. All surgery was performed at no more than 2 contiguous levels, by one surgeon (S.M.E.). After anterior discectomy alone, or combined with posterior vertebral body margin osteophytectomy, anterior bone grafting (Smith-Robinson) was performed at each level using a tricortical autogenous iliac crest bone block inserted under compression. In the interests of maximizing resource allocation and minimizing potential complications, all surgery was completed without internal fixation. A postoperative semirigid cervical collar was prescribed for 2 months. In 54 patients having 1-level fusion, there were 6 pseudarthroses (11%). In 43 patients having 2-level fusion, 12 patients demonstrated pseudarthroses (28% of patients) at a total of 18 levels (21% of levels). Only 2 of the 97 patients had pain related to the donor site. These results tend to confirm published reports of high pseudarthrosis rates in anterior cervical fusions carried out at 2 or more levels without fixation, as against improved fusion rates when internal fixation is applied. The authors are inclined to change their practice to include internal fixation in the form of anterior plating for fusions carried out at more than one level. Patients with technically successful fusions were less likely to have postoperative neck pain. Donor site pain was not a significant postoperative complication.

Occipital condyle fracture in a victim of a motor vehicle collision

Occipital condyle fractures are rarely reported in the Emergency Medicine literature. It is unclear whether these fractures are rare or under-diagnosed. Occipital condyle fractures are associated with high-energy blunt trauma with significant cranial-cervical torque or axial loading. We report a case of a female patient with an occipital condyle fracture. The patient only complained of shoulder pain, but was found to have high cervical spine tenderness, after a moderate-speed front-end motor vehicle collision. Initial cervical spine radiographs were non-diagnostic. Computed tomography of the cervical spine demonstrated a non-displaced occipital condyle fracture. Conservative management with a semi-rigid cervical collar was successful in treating this patient’s fracture. A review of the literature covers the diagnosis, radiographic findings, and management of this fracture.

Reduction in mouth opening with semi-rigid cervical collars

Reduced mouth opening may be a major contributing factor to the deterioration in the view obtained at laryngoscopy when a semi-rigid cervical collar is in place. We set out to assess the degree to which mouth opening is restricted by a cervical collar. We measured maximal inter-incisor distance in 52 volunteers. It was measured again after application of each of three appropriately sized semi-rigid cervical collars (Stifneck, Miami J, and Philadelphia). Inter-incisor distance was significantly reduced by the application of a cervical collar [No collar 41 (7) mm-mean (SD); Stifneck 26 (8) P<0.0001; Miami J 29 (9) P<0.0001; Philadelphia 29 (9) P<0.0001]. There was a wide and unpredictable variation between subjects in the reduction in mouth opening and a significant proportion had an inter-incisor distance of 20 mm or less (Stifneck, 25%; Miami J, 21%; Philadelphia, 21%). Application of a semi-rigid cervical collar can significantly reduce mouth opening. This could hinder definitive airway placement. Our results support removing the anterior portion of the collar before attempts at tracheal intubation.

C OMPARISON OF T IMES TO I NTUBATE A S IMULATED T RAUMA P ATIENT IN T WO P OSITIONS

Background. The nature of the trauma patient's injuries may compromise the airway and ultimately lead to death or neurological devastation. The same injuries complicate protecting the airway in these patients by preventing manipulation of the cervical spine for direct laryngoscopy. A recent study has shown that misplaced endotracheal tubes occur significantly more often in trauma patients than in medical patients. Objectives. The authors hypothesized that elevating the long spine board would reduce the amount of time required for paramedics to intubate a simulated trauma patient. Methods. Paramedics from an urban emergency medical services division were given up to two opportunities to intubate a manikin in a type I ambulance in each of two positions in random order: supine and with the head elevated. The manikin was secured to a long spine board with three straps, a semi-rigid cervical collar, and a cervical immobilization device. An investigator maintained cervical spine alignment and provided cricoid pressure. The elevated position was accomplished by raising the head of the stretcher 27°, resulting in 7° of spine board elevation. Each attempt was timed. If the first attempt was unsuccessful, the times for both the first and second attempts were totaled to determine the total time required for intubation. Times for successful intubation in each position were compared with a Mann-Whitney test. First-attempt success rates for each position were compared with χ2 analysis. Multinomial regression was used to determine whether experience, paramedic height, or previous intubation success influenced intubation time in either position. Results. Fifty-five paramedics provided informed consent and completed the study. Average time to intubate the supine manikin was significantly longer than needed to intubate the head-elevated manikin (35.6 ± 19.0 seconds vs 27.9 ± 12.8 seconds, p = 0.025). The manikin was successfully intubated on the first attempt 84% in the supine position and 95% in the head-elevated position (p = 0.200). Regression analysis identified intubation position as the only significant predictor of intubation time (p = 0.007). Conclusions. Modest elevation of the head of an immobilized patient appears to allow more rapid intubation. With the spine board properly secured to the stretcher, this technique potentially offers improved intubation time without additional cost or equipment.

Skin necrosis caused by a semi-rigid cervical collar in a ventilated patient with multiple injuries

A I9-year-old girl was involved in a road traffic accident and was trapped in her car sustaining multiple injuries. A two piece semi-rigid collar was applied at the scene. She was managed according to Advanced Trauma Life Support protocols by an Accident Flying Squad. Her injuries consisted of a tear in the small bowel mesentery requiring emergency surgery for haemorrhage, cerebral oedema, fractures of the left acetabulum and left twelfth rib, and pulmonary contusions. The initial cervical spine radiograph failed to include C7 Tl and therefore the collar was left on. She had a persistent tachycardia of around lOO/min and one brief hypotensive episode (80 mmHg systolic) prior to theatre, which responded rapidly to fluid resuscitation. Total volume resuscitation consisted of 2 litres of colloid and 4 units of blood. After theatre and computerized tomographic scan she was ventilated on the intensive care unit. The following day further radiographs of the cervical spine were performed and reported as normal. The collar was removed 36 h after its application, at which time areas of skin necrosis were noted over the angles of the jaw (Figure 7) and indentations in the skin of the occiput and chest.