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

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Abstract

Introduction

Rigid cervical spine following trauma immobilization is recommended to reduce neurological disability and provide spinal stability. Soft collars have been proposed as a good alternative because of the complications related to rigid collars. The purpose of this study was to perform a systematic review on soft and rigid collars in the prehospital management of cervical trauma.

Method

A systematic review was performed following the PRISMA guidelines. Search terms were (immobilization) AND (collar) AND ((neck) OR (cervical)) to evaluate the range of motion (ROM) and evidence of clinical outcome for soft and rigid collars.

Results

A total of 18 studies met eligibility criteria including 2 clinical studies and 16 articles investigating the range of motion (ROM). Four hundred and ninety-six patients at a mean age of 32.5 years (SD 16.8) were included. Measurements were performed in a seated position in twelve studies. Eight articles reported the ROM without a collar, 7 with a soft collar, and 15 with a rigid collar. There was no significant difference in flexion/extension, bending and rotation following immobilization with soft collars compared to no collar. Rigid collars provided significantly higher stability compared to no collar (p < 0.005) and to soft collars in flexion/extension and rotation movements (p < 0.05). The retrospective clinical studies showed no significant differences in secondary spinal cord injuries for soft collar (0.5%) and for rigid collar (1.1%). One study, comparing immobilization without a collar compared to that with a rigid collar, found a significant difference in neurologic deficiency and supraclavicular nerve lesion.

Conclusion

Although rigid collars provide significant higher stability to no collar and to soft collars in flexion/ extension and rotation movements, clinical studies could not confirm a difference in neurological outcome.

Level of Evidence

II, Systematic Review.

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Acknowledgement

We would like to thank Robert Röhle, M.Sc. at the Charité Berlin, University Hospital Berlin, Germany, for his help with the meta-analysis.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, USA

    Henrik C. Bäcker, Patrick Elias, Peter Turner & John Cunningham

  2. Epworth Hospital Richmond, 89 Bridge Road, Richmond, VIC, 3121, USA

    Henrik C. Bäcker, Michael A. Johnson, Peter Turner & John Cunningham

  3. Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital Berlin, Berlin, Germany

    Henrik C. Bäcker & Karl F. Braun

  4. Department of Trauma Surgery, Technical University Munich, Klinikum Rechts Der Isar, Munich, Germany

    Karl F. Braun

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Bäcker, H.C., Elias, P., Braun, K.F. et al. Cervical immobilization in trauma patients: soft collars better than rigid collars? A systematic review and meta-analysis. Eur Spine J 31, 3378–3391 (2022). https://doi.org/10.1007/s00586-022-07405-6

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