Adverse Events Relating to Prolonged Hard Collar Immobilisation: A Systematic Review and Meta-Analysis

Abstract

Study Design Systematic review and meta-analysis. Objective To evaluate systematically the complications of prolonged cervical immobilisation in a hard collar. Methods Following registration with PROSPERO, a systematic search of electronic databases (MEDLINE, EMBASE) was conducted. Two reviewers independently screened the search results according to pre-determined search criteria. Data was extracted and tabulated. Joanna Briggs Institute checklists were used for assessing the quality of included studies. Results The search identified 773 articles. A total of 25 studies were selected for final inclusion. The results largely comprised a mixture of case reports/series, cohort studies and reviews. The most commonly reported complications were pressure ulcers, dysphagia and increased intracranial pressure. A pressure ulcer pooled prevalence of 7% was calculated. There was insufficient data for quantitative analysis of any other complication. Conclusions There is significant morbidity from prolonged hard collar immobilisation, even amongst younger patients. Whilst based upon limited and low-quality evidence, these findings, combined with the low-quality evidence for the efficacy of hard collars, highlights a knowledge gap for future research.

Facet Distraction and Dysphagia: A Prospective Evaluation of This Common Postoperative Issue Following Anterior Cervical Spine Surgery

“…However, the absolute difference in Bazaz dysphagia scores were small and likely did not present with a clinically significant difference between groups. Similar rates of postoperative dysphagia in the immediate and subacute postoperative period may arise due to consistent bracing protocols wherein all patients were prescribed a cervical orthosis for six weeks 43,44. The increased dysphagia in patients with greater IFDD at later time points may be due to persistent distraction effects beyond the dysphagia that may result from orthosis use, although this purely speculative.…”

“…Similar rates of postoperative dysphagia in the immediate and subacute postoperative period may arise due to consistent bracing protocols wherein all patients were prescribed a cervical orthosis for six weeks. 43,44 The increased dysphagia in patients with greater IFDD at later time points may be due to persistent distraction effects beyond the dysphagia that may result from orthosis use, although this purely speculative. Further, the effect of facet distraction on long-term dysphagia is unclear since our study population consisted of patients with one-year follow-up.…”

Cervical spine immobilisation following blunt trauma in pre-hospital and emergency care: A systematic review

“…To distinguish from emergency immobilisation, a systematic review by Brannigan et al, [ 38 ] based on limited and low-quality evidence, also found that prolonged use of hard collars (≥2 days of wear) was associated with significant morbidity including pressure sores, dysphagia, raised intracranial pressure and peripheral nerve palsies and may be detrimental to a patient’s outcome.…”

Uncovertebral Joint Fusion Versus End Plate Space Fusion in Anterior Cervical Spine Surgery

“…First, preventing pseudarthrosis is still the most common reason why spine surgeons recommend that patients wear a cervical brace 22 , although its effectiveness in preventing pseudarthrosis or implant migration is in dispute 23,24 . Also, cervical bracing is associated with complications 25,26 such as dysphagia, stiffness of neck muscles, and pressure ulcers, and it often hinders patients with respect to returning to work. Early fusion could reduce unnecessary prolonged cervical brace wear and allow earlier return to work.…”