Cervical collar

A cervical collar, often called a neck brace, is a specialized medical device. Its primary purpose is to support and immobilize the human neck. Immobilization means restricting the movement of the cervical spine. This is vital when a person has sustained a traumatic head or neck injury. Such injuries can lead to a cervical fracture, which is a break in the neck bones. If the spine is broken, movement could cause a spinal cord injury. This injury could result in paralysis or even death.

Medical professionals use various types of collars depending on the injury. A soft collar is often made of felt and is fairly flexible. These are used for minor injuries or after a neck has become stable during healing. However, soft collars carry a high risk of further breakage in patients with osteoporosis. Rigid collars are more common for serious stabilization. These often feature a firm, bi-valved plastic shell. They use Velcro straps and removable padded liners to stay secure. A rigid collar typically includes a chin pad, a front pad, a back pad, and a back panel. Some models use plexiglass to provide extra rigidity. Many rigid designs also include air holes for ventilation or to allow access for a tracheostomy.

Applying a cervical collar is a precise medical procedure. First, a practitioner should remove any clothing or jewelry from the neck area. The practitioner must then choose a collar size that fits the patient's specific build. They must carefully measure the length of the patient's neck. During application, one person holds the neck perfectly still. A second person then places the collar and locks it to the measured length. The chin must sit correctly in the chin piece. Additionally, the collar must extend down to the sternal notch. If a patient has a tracheostomy, the medical team must ensure the hole remains midline and accessible.

Care after application is just as important as the initial fit. The collar must be tight enough to stop movement but loose enough to prevent harm. If a collar is too tight, it can cause pressure on the vasculature, or blood vessels. It can also cause strangulation or pressure ulcers, which are skin sores. Medical staff must evaluate and clean both the collar and the patient's neck frequently. To clean the area, two people are needed. One person holds the neck to keep it aligned. The other person unfastens the straps and removes the collar. The skin is then cleaned with soap, water, and washcloths. If the skin breaks down, doctors may use topical agents or antibiotics.

The history of the cervical collar began in 1966. George Cottrell invented the device during the Vietnam War. He wanted to provide neck immobilization for American soldiers with unstable neck injuries. Later, an orthopedic surgeon named Dr. JD Farrington popularized its use in prehospital care. In his paper, "Death in a Ditch," he described the dangerous way victims were removed from vehicles. He argued that a standardized approach using collars could prevent further injury during extraction.

While once widely used, the routine use of cervical collars is now less common. Recent clinical trials have led to a significant reduction in immobilization. Doctors found that collars can cause complications like increased intracranial pressure in brain injury patients. They can also make it difficult to manage a patient's airway. In the elderly, collars might increase the chance of spinal fracture displacement. Some medical professionals have even suggested a ban on their routine use. They argue that the risks, such as limited physical exams and neck pain, may outweigh the benefits. In cases of isolated penetrating injuries without neurological deficits, collars are not recommended.

Despite these debates, collars serve many specific medical roles. They are used therapeutically to help realign the spinal cord or relieve pain. They are also used for strains, sprains, or whiplash. Some patients require a more intense device, like a halo fixation device, after surgery such as a cervical spinal fusion. In high-risk sports like Motocross or go-kart racing, athletes wear protective collars. These designs range from simple foam to complex composite devices to prevent whiplash. Even in sleep medicine, collars may be used for sleep apnea or CPAP ventilation to optimize neck position and keep airways clear.