Cervical immobilization in trauma patients: soft collars better than rigid collars? A systematic review and meta-analysis

Bäcker, Henrik C.; Elias, Patrick; Braun, Karl F.; Johnson, Michael A.; Turner, Peter; Cunningham, John

doi:10.1007/s00586-022-07405-6

Cited by 7 publications

(8 citation statements)

References 49 publications

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“…85 A recent systematic review of eighteen studies comparing no collar, soft collar, and rigid collar could not confirm any difference in neurological outcome for any of these interventions. 86 Another multicenter consecutive case series comparing soft collars against rigid collars showed no risk for secondary spinal injury. 87 Two different explorative, biomechanical studies showed no increased benefit to neck movement with additional application of rigid cervical collar—one comparing its application to backboard or vacuum splint, another comparing its application to self-extrication.…”

Section: Scope Of the Problemmentioning

confidence: 97%

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update

Hawkins,

Williams,

Bennett

et al. 2024

Wilderness & Environmental Medicine

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The Wilderness Medical Society reconvened an expert panel to update best practice guidelines for spinal cord protection during trauma management. This panel, with membership updated in 2023, was charged with the development of evidence-based guidelines for management of the injured or potentially injured spine in wilderness environments. Recommendations are made regarding several parameters related to spinal cord protection. These recommendations are graded based on the quality of supporting evidence and balance the benefits and risks/burdens for each parameter according to American College of Chest Physicians methodology. Key recommendations include the concept that interventions should be goal-oriented (spinal cord/column protection in the context of overall patient and provider safety) rather than technique-oriented (immobilization). An evidence-based, goal-oriented approach excludes the immobilization of suspected spinal injuries via rigid collars or backboards.

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Section: Scope Of the Problemmentioning

confidence: 97%

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update

Hawkins,

Williams,

Bennett

et al. 2024

Wilderness & Environmental Medicine

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“…However, in recent years, the efficacy of these braces has been questioned due to the lack of evidence-based research on prehospital spinal bracing [ 16 , 17 ]. Further, recent studies found that pre-hospital bracing heightens the risk for pulmonary restriction [ 18 – 20 ], decubitus ulceration [ 21 , 22 ], and increased intracranial pressure [ 14 , 23 – 26 ]. A randomized control trial (RCT) by Dixon et al also demonstrated that patient extrication maneuvers with equipment, including cervical collars, resulted in four times more cervical spine movement than self-extrication without bracing equipment [ 27 ].…”

Section: Spinal Bracing Practices En Route To the Ermentioning

confidence: 99%

“…These new findings have been followed by a shift to systematically grade the need for prehospital bracing on a case-by-case basis, partially influenced by the National Emergency X-Radiography Utilization Study Group (NEXUS) and the Canadian C-Spine rules (CCR), which are both used in hospital settings [ 21 , 28 , 29 ]. Other studies are beginning to compare the prehospital use of soft versus rigid cervical braces [ 26 ]. Notably, a systematic review and meta-analysis by Backer et al published in the European Spine Journal in 2022 suggested that soft cervical collars be the standard as they had fewer complications [ 26 ].…”

Section: Spinal Bracing Practices En Route To the Ermentioning

confidence: 99%

“…Other studies are beginning to compare the prehospital use of soft versus rigid cervical braces [ 26 ]. Notably, a systematic review and meta-analysis by Backer et al published in the European Spine Journal in 2022 suggested that soft cervical collars be the standard as they had fewer complications [ 26 ]. The increased efficacy of soft collars is an unprecedented recommendation, given that rigid collars or a combination of semi-rigid collars with bolsters or straps have been the standard since their inception in the 1960s [ 12 , 14 ].…”

Section: Spinal Bracing Practices En Route To the Ermentioning

confidence: 99%

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Spine Bracing: When to Utilize—A Narrative Review

et al. 2023

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Spinal bracing is a common non-surgical technique that allows clinicians to prevent and correct malformations or injuries of a patient’s spinal column. This review will explore the current standards of practice on spinal brace utilization. Specifically, it will highlight bracing usage in traumatic injuries, pregnancy, pediatrics, osteoporosis, and hyperkyphosis; address radiological findings concurrent with brace usage; and provide an overview of the braces currently available and advancements in the field. In doing so, we aim to improve clinicians’ understanding and knowledge of bracing in common spinal pathologies to promote their appropriate use and improve patient outcomes.

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“…However, clinical studies have not confirmed any differences in neurological outcomes. The review concluded that no clinical evidence is available to support the need to apply a rigid collar, and soft collars provide adequate stability and a sense of immobilization for patients, leading to increased compliance [63].…”

Section: Necessity Of Collar Immobilization In the Acute Phase: Rigid...mentioning

confidence: 99%

Management of Cervical Spinal Cord Injury without Major Bone Injury in Adults

Nakajima,

Honjoh,

Watanabe

et al. 2023

JCM

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The incidence of cervical spinal cord injury (CSCI) without major bone injury is increasing, possibly because older people typically have pre-existing cervical spinal canal stenosis. The demographics, neurological injury, treatment, and prognosis of this type of CSCI differ from those of CSCI with bone or central cord injury. Spine surgeons worldwide are debating on the optimal management of CSCI without major bone injury. Therefore, this narrative review aimed to address unresolved clinical questions related to CSCI without major bone injury and discuss treatment strategies based on current findings. The greatest divide among spine surgeons worldwide hinges on whether surgery is necessary for patients with CSCI without major bone injury. Certain studies have recommended early surgery within 24 h after injury; however, evidence regarding its superiority over conservative treatment remains limited. Delayed MRI may be beneficial; nevertheless, reliable factors and imaging findings that predict functional prognosis during the acute phase and ascertain the necessity of surgery should be identified to determine whether surgery/early surgery is better than conservative therapy/delayed surgery. Quality-of-life assessments, including neuropathic pain, spasticity, manual dexterity, and motor function, should be performed to examine the superiority of surgery/early surgery to conservative therapy/delayed surgery.

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Cervical immobilization in trauma patients: soft collars better than rigid collars? A systematic review and meta-analysis

Cited by 7 publications

References 49 publications

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update

Spine Bracing: When to Utilize—A Narrative Review

Management of Cervical Spinal Cord Injury without Major Bone Injury in Adults

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