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Zhang T, Gao G, Li Y, Gao F, Yang W, Wang Y, Guo N. Comparison of outcomes after anterior cervical discectomy and fusion with and without a cervical collar: a systematic review and meta-analysis. J Orthop Surg Res 2024; 19:172. [PMID: 38454504 PMCID: PMC10919030 DOI: 10.1186/s13018-024-04661-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/02/2024] [Indexed: 03/09/2024] Open
Abstract
PURPOSE The clinical outcomes of patients who received a cervical collar after anterior cervical decompression and fusion were evaluated by comparison with those of patients who did not receive a cervical collar. METHODS All of the comparative studies published in the PubMed, Cochrane Library, Medline, Web of Science, and EMBASE databases as of 1 October 2023 were included. All outcomes were analysed using Review Manager 5.4. RESULTS Four studies with a total of 406 patients were included, and three of the studies were randomized controlled trials. Meta-analysis of the short-form 36 results revealed that wearing a cervical collar after anterior cervical decompression and fusion was more beneficial (P < 0.05). However, it is important to note that when considering the Neck Disability Index at the final follow-up visit, not wearing a cervical collar was found to be more advantageous. There were no statistically significant differences in postoperative cervical range of motion, fusion rate, or neck disability index at 6 weeks postoperatively (all P > 0.05) between the cervical collar group and the no cervical collar group. CONCLUSIONS This systematic review and meta-analysis revealed no significant differences in the 6-week postoperative cervical range of motion, fusion rate, or neck disability index between the cervical collar group and the no cervical collar group. However, compared to patients who did not wear a cervical collar, patients who did wear a cervical collar had better scores on the short form 36. Interestingly, at the final follow-up visit, the neck disability index scores were better in the no cervical collar group than in the cervical collar group. PROSPERO registration number: CRD42023466583.
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Affiliation(s)
- Tingxin Zhang
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Gang Gao
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Yanhong Li
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Feng Gao
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Wupeng Yang
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China
| | - Yongjiang Wang
- Department of Orthopedics, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China.
| | - Nana Guo
- Department of Critical Care Medicine, Ordos Central Hospital, 23 Ekin Hollow West Street, Ordos, 017000, China.
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Russell LJ, Dodd T, Kendall D, Lazenbury A, Leggett A, Payton-Haines S, Jiang L, Filingeri D, Worsley PR. A bioengineering investigation of cervical collar design and fit: Implications on skin health. Clin Biomech (Bristol, Avon) 2024; 112:106178. [PMID: 38232471 DOI: 10.1016/j.clinbiomech.2024.106178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/13/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Cervical collars restrict cervical spine movement to minimise the risk of spinal cord injury. Collars apply mechanical loading to the skin putting it at risk of skin damage. Indeed, cervical collar-related pressure ulcers are unacceptably prevalent, especially at the occiput, mandibles, and chin. Collar design and fit are often key considerations for prevention. METHODS This comprehensive study evaluated four commercial prehospital and acute care cervical collars. Pressure, microclimate, transepidermal water loss and skin hydration were measured at the interface between the device and the skin. Range of motion restriction was measured to evaluate effective immobilisation. Head, neck, and shoulder morphology was evaluated using three-dimensional scans. FINDINGS The occiput experienced significantly higher interface pressures than the chin and mandibles for most collar designs. Interface pressure at the occiput was significantly higher for the Stiffneck extrication collar compared to the other collar designs. The Stiffneck collar also provided the most movement restriction, though not significantly more than other designs. Relative humidity at the device skin interface was significantly higher for the Stiffneck and Philadelphia collars corresponding to closed cell foam padding, in contrast to the open cell foams lined with permeable fabric used in the other collars. Collar discomfort correlated with both occipital pressure and skin humidity. INTERPRETATION The occiput is at increased risk of cervical collar-related pressure ulcers during supine immobilisation, especially for Stiffneck extrication collars. Lined open-cell foams could be used to minimise skin humidity and increase comfort.
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Affiliation(s)
- Laurence J Russell
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
| | - Tamara Dodd
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Daniel Kendall
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Amber Lazenbury
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Abigail Leggett
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Sophie Payton-Haines
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Liudi Jiang
- School of Engineering, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK
| | - Davide Filingeri
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Peter R Worsley
- Skin Sensing Research Group, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
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Wu EY, Curran PL, Zukowski M, King TS, Martin KL, Grant CN. Cervical Collar Clearance in Obtunded Children Presenting Without a Known Traumatic Mechanism: Is Imaging Necessary? J Pediatr Surg 2023; 58:1494-1499. [PMID: 37029027 DOI: 10.1016/j.jpedsurg.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Obtunded pediatric patients are often placed in cervical collars (c-collars) to protect their cervical spine (c-spine) while injury is being ruled out, even without a known traumatic injury. The goal of this study was to determine the necessity of c-collars in this population by determining the rate of c-spine injury among patients with suspected non-traumatic mechanisms of loss of consciousness. METHODS A single institution, ten-year retrospective chart review was conducted including all obtunded patients admitted to the Pediatric Intensive Care Unit without a known traumatic event. Patients were categorized into five groups based on etiology of obtundation: respiratory, cardiac, medical/metabolic, neurologic, and other. Comparisons were made between those placed in a c-collar and a control group who were not, using Wilcoxon rank sum test for continuous measures, and Chi-square or Fisher's exact test for categorical measures. RESULTS 464 patients were included, of which 39 (8.41%) were placed in a c-collar. There was a significant difference in whether a patient was placed in a c-collar based on diagnosis category (p < 0.001). Those placed in a-c-collar were more likely to undergo imaging studies than the control group (p < 0.001). The overall incidence of c-spine injury in this patient population in our study was zero. CONCLUSION Cervical collar placement and radiographic evaluation is not necessary in obtunded pediatric patients who present without a known traumatic mechanism as the overall risk of injury is low. Consideration for collar placement should be given in cases when trauma cannot be definitively ruled out at initial evaluation. LEVELS OF EVIDENCE III.
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Affiliation(s)
- Emma Y Wu
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Pierce L Curran
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Monica Zukowski
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA
| | - Tonya S King
- Department of Public Health Sciences, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA
| | - Kathryn L Martin
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA; Department of Surgery, Division of Pediatric Surgery, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA
| | - Christa N Grant
- Penn State College of Medicine, 700 HMC Cres Rd, Hershey, PA 17033, USA; Department of Surgery, Division of Pediatric Surgery, Penn State Hershey Medical Center, 500 University Dr, Hershey, PA 17033, USA.
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Hoseini Kasnavieh M, Kookli K, Veisi M, Amerzadeh M, Hosseinifar H, Tahmasebi A. Investigating the Rate and Affecting Factors of Unnecessary Cervical Collar Use in Trauma Patients. Bull Emerg Trauma 2023; 11:178-183. [PMID: 38143523 PMCID: PMC10743316 DOI: 10.30476/beat.2023.98793.1441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 08/05/2023] [Accepted: 08/29/2023] [Indexed: 12/26/2023] Open
Abstract
Objective This study aimed to investigate the necessity of cervical collars in patients with neck problems. Methods This cross-sectional study was conducted on 114 patients who were admitted to the Haft Tir and Rasoul Akram Hospitals (Tehran, Iran) from August to September 2022. The Nexus protocol was used to select the patients with cervical collars. According to the protocol, a cervical collar was required for individuals who had at least one symptom. If none of these symptoms existed, the cervical collar was deemed unnecessary. The data were analyzed using the Chi-square test and Fisher's exact test. Results Of the 114 trauma patients, the cervical collar was used unnecessarily by 49 (43%) patients. Tenderness was the most common complication in 62 patients (54.4%). The prevalence of unnecessary cervical collar use was 37.5% in female trauma patients and 43.88% in male trauma patients, which was not statistically significant (p=0.63). The prevalence of unnecessary cervical collar use in trauma patients with multiple trauma was 39.42% and 80% in patients without multiple trauma, which was statistically significant (p=0.018). Patients with a medical history had a higher rate of unnecessary use of the cervical collar (47.96%) than those without a history (12.5%), and this difference was statistically significant (p=0.008). Conclusion The guidelines for using cervical collars need to be updated by the EMS. Due to the large number of trauma patients in Iran, cervical collars for necessary conditions can help to reduce the healthcare expenses and injuries caused by unnecessary cervical collars.
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Affiliation(s)
| | - Keihan Kookli
- International Campus, Iran University of Medical Sciences, Tehran, Iran
| | - Mohamad Veisi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Amerzadeh
- Department of Health Services Management, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hossein Hosseinifar
- Evidence-Based Medicine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ali Tahmasebi
- Hospital Management Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
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Araghi K, Jacofsky M, McCamley J. Comparison of cervical motion restriction and interface pressure between two cervical collars. Clin Biomech (Bristol, Avon) 2021; 89:105482. [PMID: 34537462 DOI: 10.1016/j.clinbiomech.2021.105482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/04/2021] [Accepted: 09/07/2021] [Indexed: 02/07/2023]
Abstract
Background Cervical collar treatment is widespread amongst a broad range of ages and conditions. However, these devices are associated with a known correlation between collar usage and adverse effects such as pressure ulcers, infections, exacerbated spinal injury, and higher morbidity. The objective of this study was to determine if the ability of a newly developed DJO Procare XTEND 174 collar to restrict cervical spine motion was similar to that of the previously studied Össur Miami J collar and to determine if this was done while producing similar tissue interface pressures. Methods Three-dimensional kinematic data were obtained for twelve healthy volunteer participants (6 female, 6 male) using a 10-camera infrared motion capture system. Cervical range of motion in each plane was calculated using angles between head and thorax rigid-body axes. Tissue interface pressure was measured between the head and the collar with three flexible pressure sensor pads over the anterior mandibles and occiput. The distribution of interface pressures was obtained in both the seated and supine positions. Findings Both collars significantly restricted range of motion in all movement directions (p < 0.001) compared to no collar. There were no significant differences in restrictiveness nor in tissue interface pressures between the collars. Both collars exhibited similar range of motion restriction and similar interface pressures. Interpretation Our data indicate that the newly developed Procare XTEND 174 collar is not statistically different from the scientifically recognized Miami J benchmark collar regarding cervical range of motion restriction in all three planes and tissue interface pressure.
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Affiliation(s)
- Kasra Araghi
- MORE Foundation, 18444 N 25(th) Ave. Suite 110, Phoenix, AZ 85023, USA.
| | - Marc Jacofsky
- MORE Foundation, 18444 N 25(th) Ave. Suite 110, Phoenix, AZ 85023, USA; The CORE Institute, 18444 N 25(th) Ave. Suite 320, Phoenix, AZ 85023, USA.
| | - John McCamley
- MORE Foundation, 18444 N 25(th) Ave. Suite 110, Phoenix, AZ 85023, USA.
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Jung MK, Uzun DD, von Ehrlich-Treuenstätt GVR, Grützner PA, Kreinest M. [The position of the head during treatment in the emergency room-an explorative analysis of immobilization of the cervical spine]. Anaesthesist 2021. [PMID: 33909105 DOI: 10.1007/s00101-021-00965-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/23/2021] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Immobilization of the cervical spine is a standard procedure in emergency medicine mostly achieved via a cervical collar. In the emergency room other forms of immobilization are utilized as cervical collars have certain drawbacks. The present study aimed to provide preliminary data on the efficiency of immobilization in the emergency room by analyzing the residual spinal motion of the patient's head on different kinds of head rests. METHODS In the present study biomechanical motion data of the cervical spine of a test subject were analyzed. The test subject was placed in a supine position on a mobile stretcher (Stryker M1 Roll-In System, Kalamazoo, MI, USA) wearing a cervical collar (Perfit ACE, Ballerup, Denmark). Three different head rests were tested: standard pillow, concave pillow and cavity pillow. The test subject carried out a predetermined motion protocol: right side inclination, left side inclination, flexion and extension. The residual spinal motion was recorded with wireless motion trackers (inertial measurement unit, Xsens Technologies, Enschede, The Netherlands). The first measurement was performed without a cervical collar or positioning on the pillows to measure the physiological baseline motion. Subsequently, three measurements were taken with the cervical collar applied and the pillows in place. From these measurements, a motion score was calculated that can represent the motion of the cervical spine. RESULTS When the test subject's head was positioned on a standard pillow the physiological motion score was reduced from 69 to 40. When the test subject's head was placed on concave pillow the motion score was further reduced from 69 to 35. When the test subject's head was placed on cavity pillow the motion score was reduced from 69 to 59. The observed differences in the overall motion score of the cervical spine are mainly due to reduced flexion and extension rather than rotation or lateral inclination. CONCLUSION The motion score of the cervical spine using motion sensors can provide important information for future analyses. The results of the present study suggest that trauma patients can be immobilized in the early trauma phase with a cervical collar and a head rest. The application of a cervical collar and the positioning on the concave pillow may achieve a good immobilization of the cervical spine in trauma patients in the early trauma phase.
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Liu YC, Huang WC, Tan ECH, Huang SS, Wang YK, Chu YC. Practice and outcomes of airway management in patients with cervical orthoses. J Formos Med Assoc 2021; 121:108-116. [PMID: 33642124 DOI: 10.1016/j.jfma.2021.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/30/2020] [Accepted: 02/02/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND/PURPOSE Increasing evidence indicates an association of video laryngoscopy with the success rate of airway management in patients with neck immobilization. Nevertheless, clinical practice protocols for tracheal intubation in patients immobilized using various types of cervical orthoses and the outcomes remain unclear. METHODS We retrospectively assessed the tracheal intubation techniques selected for patients immobilized using cervical orthoses from 2015 to 2018. The endpoints were the intubation outcomes of the different techniques and the factors associated with the selection of the technique. RESULTS We included 218 patients, 118 of whom wore halo vest braces (halo vest group) and 100 wore cervical collars (collar group). GlideScope video laryngoscopy (GVL) and fiberoptic bronchoscopy (FOB) were the initial intubation methods in 98 and 120 patients, respectively. GVL had a higher first-attempt success rate than did FOB in the collar group (p = 0.002) but not in the halo vest group (p = 0.522). GVL was associated with a lower risk of episodes of SaO2< 90% (adjusted relative risk [aRR], 0.11; 95% CI, 0.02-0.67; p = 0.016) and shorter intubation time (aRR, -3.52; 95% CI, -4.79∼-2.25; p < 0.001) in the collar group. However, in the halo vest group, more frequent requirement of a rescue technique (p = 0.002) and necessity of patient awakening (p = 0.001) was noted when GVL was used. Use of the halo vest brace and noting of severe cord compression were independent predictors of the initial selection of FOB. CONCLUSION Caution should be exercised when using GVL for tracheal intubation in patients immobilized using halo vest braces.
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Affiliation(s)
- Yu-Chun Liu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei and Institute of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei and School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Elise Chia-Hui Tan
- National Research Institute of Chinese Medicine, Ministry of Health and Welfare, Taipei and Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Shiang-Suo Huang
- Department of Pharmacology, Institute of Medicine, Chung Shan Medical University, and Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yen-Kai Wang
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei and Institute of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan
| | - Ya-Chun Chu
- Department of Anesthesiology, Taipei Veterans General Hospital, Taipei and Institute of Medicine, National Yang Ming Chiao Tung University, Hsinchu, 30010, Taiwan.
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Ala A, Vahdati SS, Maroufi P, Hafezan S, Ansari N, Ghabousian A. Philadelphia versus Miami-J cervical collar's impact on pulmonary function. Am J Emerg Med 2021; 43:59-61. [PMID: 33524684 DOI: 10.1016/j.ajem.2021.01.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/06/2021] [Accepted: 01/17/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the effect of two types of cervical collars (Philadelphia and Miami-J) on pulmonary function and ventilation in healthy volunteers through spirometry, peak flow meter, and capnograph. METHOD Initially, subjects were randomized into two groups in which the sequence of collars' fixation was reversed. Afterward, we assessed the pulmonary parameters without a cervical collar in all participants. Each group underwent two additional test conditions, including measurements after wearing a Philadelphia and Miami-J cervical collar. In any case, we took the measurements half an hour after the collar fixation. RESULTS The mean age of participants was 48.34 ± 1.35 years. Following either type of collars application, there was a statistically significant decrease in FEV1, FEV1/FVC, FEF25-75%, and PEF (p < .001). However, FVC was not significantly changed (p = .157). CONCLUSION In summary, we noted a statistically significant expiratory flow obstruction after both the Philadelphia and Miami-J cervical collar. These changes were not clinically significant in healthy volunteers, albeit may have ramifications in patients with pre-existing respiratory compromise.
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Kim JY, Cho JH, Yoon SH, Cho SM, Lim YC. New Simple 3-Dimensional Computed Tomogram Classification Leading to Successful Conservative Treatment in 51 Atlanto-Axial Rotatory Fixation Children. Pediatr Neurosurg 2021; 56:125-132. [PMID: 33611332 DOI: 10.1159/000512368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE to present a new and easy classification of atlanto-axial rotatory fixation (AARF) and to investigate the efficiency of conservative treatment of AARF. BACKGROUND Although there is a precise definition and diagnostic classification of AARF, there is still significant difficulty in measuring the atlas and axis angles because all of the atlas or axis cannot be seen in a certain 2-dimensional computed tomogram image. In addition, some recent case reports showed that long-term conservative treatment can reduce pediatric AARFs, even that are severe or chronic. METHODS Fifty-one children with AARF were analyzed retrospectively with new 3-dimensional computed tomogram (3DCT)-based AARF classification; the mean age was 72.7 ± 35.2 months (19-139 months). In the new AARF classification, type 1 was defined as that when the C1C2 angle is not 0° on midline and type 2 as that when the C1C2 angle is 0° on the midline. RESULTS All 7 children with AARF type 1 were treated successfully only with Halter tractions. Twenty among 44 children with type 2 did not show any difference in improvement compared with not-treated 24 children with type 2. CONCLUSION The first new AARF classification based on 3DCT appears to be easy to use and even the most severe children with AARF may be managed only with conservative treatment such as long-term Halter traction.
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Affiliation(s)
- Jong Yeon Kim
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Jae Ho Cho
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Soo Han Yoon
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea,
| | - Sung Min Cho
- Department of Neurosurgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Yong Cheol Lim
- Department of Neurosurgery, Ajou University School of Medicine, Suwon, Republic of Korea
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Drain J, Wilson ES, Moore TA, Vallier HA. Does prehospital spinal immobilization influence in hospital decision to obtain imaging after trauma? Injury 2020; 51:935-41. [PMID: 32113741 DOI: 10.1016/j.injury.2020.02.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 02/19/2020] [Indexed: 02/02/2023]
Abstract
IMPORTANCE This study highlights the unnecessarily high suspicion for cervical spine injury among study providers and shows that cervical CT scans were more likely in patients who arrived to the emergency department wearing a cervical collar, even when clinically cleared for suspicion of cervical spine injury by the emergency department provider. OBJECTIVE To determine if patients with a cervical collar were more likely to undergo cervical spine imaging than those who arrived to the emergency department without a collar. DESIGN Adult trauma patients at a level 1 trauma center over 4 months (n = 1,438) were stratified by acuity (1,2, or 3), mechanism, and known injury cephalad to clavicles, defined as pain, wounds, or hematomas. Cervical spine imaging findings were recorded. RESULTS 975 patients (67.8%) had cervical CT scans. Twenty-six (1.81%) sustained a fracture or ligamentous injury, all with known injury cephalad to clavicles. 161 (11.2%) patients without injury cephalad to clavicles all had a negative cervical CT. Category 1 patients with gunshot wounds with injury cephalad to clavicles were more likely to have CT if they arrived with a collar versus without (66.7% vs 14.3%, p = 0.027). Category 2 and 3 patients with injury cephalad to clavicles after motor vehicle collision (MVC) (88.2% vs 69.6%, p = 0.011), low energy falls (88.3% vs 59.4%, p < 0.0001), and assault (86.0% vs 37.1%, p < 0.0001) underwent cervical CT more frequently if they arrived wearing a collar. Category 2 and 3 trauma patients without injury cephalad to clavicles were also more likely to undergo CT when wearing a collar after MVC (66.3% vs 21.4%, p = 0.001), low energy fall (81.8% vs 35.3%, p = 0.016), and pedestrian vs MVC (55.6% vs 12.5%, p = 0.04). CONCLUSION Certain trauma patients were more likely to undergo cervical CT if they arrived wearing a cervical collar. No conscious patients without complaints proximal to the clavicles had cervical injury.
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Abstract
Neck injuries are relatively uncommon but have the potential to cause serious and permanent disability. In athletes, injuries are most common in contact sports, and occur with direct axial loading with a forward-flexed neck. Soft tissue and peripheral nerve injuries are typically minor and self-limiting, with excellent recovery potential and return to activities based on symptoms. Concern for devastating spinal cord injuries has led to routine immobilization using spine boards and hard cervical collars. This approach may provide more harm than benefit when applied universally, and a more commonsense protocol can be used to better address potential neck injuries.
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Affiliation(s)
- Benjamin Oshlag
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Hospital, First Ave at 16th St, New York, NY 10003, USA.
| | - Tracy Ray
- Duke Sports Medicine, Duke University, 3475 Erwin Rd, Durham, NC 27705, USA
| | - Benjamin Boswell
- Dvision of Sports Medicine, Primary Care Sports Medicine, Department of Orthopedic Surgery, Department of Emergency Medicine, Case Western Reserve University School of Medicine, University Hospitals Cleveland, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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Nolte PC, Uzun DD, Häske D, Weerts J, Münzberg M, Rittmann A, Grützner PA, Kreinest M. Analysis of cervical spine immobilization during patient transport in emergency medical services. Eur J Trauma Emerg Surg 2021; 47:719-26. [PMID: 31030223 DOI: 10.1007/s00068-019-01143-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 04/22/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE It remains controversial how to immobilize the cervical spine (CS) in trauma patients. Therefore, we analyzed different CS immobilization techniques during prehospital patient transport. METHODS In this explorative, biomechanical analysis of immobilization techniques conducted in a standardized setting, we recorded CS motion during patient transport using a wireless human motion tracker on a volunteer. To interpret spinal movement a benchmark called motionscore (MS) was developed based on biomechanics of the injured spine. RESULTS We found the best spinal motion restriction using a spine board, head blocks and immobilization straps with and without a cervical collar (CC) (MS 45 vs. 27). Spinal motion restriction on a vacuum mattress with CC and head blocks was superior to no CC or head blocks (MS 103 vs. 152). An inclined vacuum mattress was more effective with head blocks than without (MS 124 vs. 187). Minimal immobilization with an ambulance cot, CC, pillow and tape was slightly superior to a vacuum mattress with CC and head blocks (MS 92 vs. 103). Minimal immobilization without CC showed the lowest spinal motion restriction (MS 517). CONCLUSIONS We suggest an immobilization procedure customized to the individual situation. A spine board should be used whenever spinal motion restriction is indicated and the utilization is possible. In some cases, CS immobilization by a vacuum mattress with CC and head blocks could be more beneficial. In an unstable status of the patient, minimal immobilization may be performed using an ambulance cot, pillow, CC and tape to minimize time on scene caused by immobilization.
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Wolan-Nieroda A, Maciejczak A, Guzik A, Przysada G, Szeliga E, Drużbicki M. Range of motion in the cervical spine after odontoid fracture treated with anterior screw fixation. J Orthop Surg Res 2019; 14:104. [PMID: 30987654 PMCID: PMC6466774 DOI: 10.1186/s13018-019-1135-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 03/27/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is believed that direct odontoid screw fixation preserves the physiological cervical range of motion following surgery. However, there are no clinical studies confirming the motion sparing value of this technique. This study aims to (1) to assess active cervical range of motion following types II and III odontoid fracture, successfully treated with anterior odontoid screw fixation, and (2) to examine the relationship between the range of motion of the head and duration of collar usage, neck pain, quality of life, and patients' age. METHODS The study involved 41 patients subjected to a procedure of direct osteosynthesis of the dens with lag screw. Following the operation all the patients had to wear a cervical collar to protect the osteosynthesis. The control group consisted of 41 individuals with no clinical diagnosis of any cervical spine disorders. The spinal motion was assessed using multi-cervical unit, taking into account bending/extension, left and right lateral flexion, and left and right axial rotation. RESULTS In the study group, spine mobility correlated with the duration of hard collar usage following the operation, with a longer duration corresponding to poorer spine mobility at the end of the treatment. Statistically significant correlation was observed in the case of extension (p < 0.021) and axial rotation (p < 0.007). In the study group, there was a negative correlation between the range of motion and the patients' age, i.e., the older the patient the poorer his/her spinal mobility (p < 0.001). CONCLUSIONS Active cervical range of motion in patients following direct osteosynthesis of the dens, augmented with a hard collar, was significantly lower than in the control population, and it correlated negatively with the duration of collar usage, the patients' age, and intensity of spinal pain.
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Affiliation(s)
- Andżelina Wolan-Nieroda
- Medical Faculty, University of Rzeszów, Kopisto 2A Avenue, 35-959, Rzeszow, Poland. .,Institute of Physiotherapy, University of Rzeszow, Warszawska 26 a, 35-205, Rzeszów, Poland.
| | - Andrzej Maciejczak
- Medical Faculty, University of Rzeszów, Kopisto 2A Avenue, 35-959, Rzeszow, Poland.,Department of Neurosurgery, St Luke Hospital, Lwowska 178 Street, 33-100, Tarnow, Poland
| | - Agnieszka Guzik
- Medical Faculty, University of Rzeszów, Kopisto 2A Avenue, 35-959, Rzeszow, Poland
| | - Grzegorz Przysada
- Medical Faculty, University of Rzeszów, Kopisto 2A Avenue, 35-959, Rzeszow, Poland
| | - Ewa Szeliga
- Medical Faculty, University of Rzeszów, Kopisto 2A Avenue, 35-959, Rzeszow, Poland
| | - Mariusz Drużbicki
- Medical Faculty, University of Rzeszów, Kopisto 2A Avenue, 35-959, Rzeszow, Poland
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Kreinest M, Goller S, Rauch G, Gliwitzky B, Frank C, Matschke S, Wölfl CG, Münzberg M. [Parameters influencing the preclinical application of cervical collars]. Unfallchirurg 2019; 120:675-682. [PMID: 27357352 DOI: 10.1007/s00113-016-0207-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The application of cervical collars is a standard procedure in emergency care of trauma patients. It is often observed that the application of cervical collars is performed incorrectly, which may lead to reduced immobilization of the cervical spine. OBJECTIVES The objective of this study was to analyze the practical skills of professional emergency care providers concerning the application of cervical collars. MATERIALS AND METHODS Emergency care professionals (n = 104) were asked to apply a cervical collar to a training doll. Each performance step was assessed separately. Furthermore, personal and occupational data of all study participants were collected using a questionnaire. RESULTS The study participants included professional rescue personnel and emergency physicians. The average occupational experience of all study participants in out-of-hospital emergency care was 11.1 ± 8.9 years. Most participants had already received training on trauma care (61 %) and felt "very confident" in handling a cervical collar (84 %). The application of the cervical collar was performed correctly in 11 % of the performances. The most common error was incorrect size adjustment of the cervical collar (66 %). No association was found between the correct application of the cervical collar and possible parameters of influence, such as working experience in emergency care or participation in trauma courses. CONCLUSIONS Despite pronounced subjective confidence regarding the application of cervical collars, this study shows that there are general deficits in the practical skills of applying cervical collars. Therefore, a critical assessment of the current training contents on the subject of trauma care must be demanded.
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Affiliation(s)
- M Kreinest
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - S Goller
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - G Rauch
- Institut für Medizinische Biometrie und Informatik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - B Gliwitzky
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - C Frank
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
- Klinik für Orthopädie und Unfallchirurgie, Klinikum Mittelbaden, Baden-Baden, Deutschland
| | - S Matschke
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
| | - C G Wölfl
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland
| | - M Münzberg
- Klinik für Unfallchirurgie und Orthopädie, BG-Unfallklinik Ludwigshafen, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Deutschland.
- PHTLS Germany Research Group, Offenbach/Queich, Deutschland.
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Hontoria Hernández MI, Gordillo Martín R, Serrano Martínez FJ, Alonso Ibáñez L, Carazo Díaz C, Prieto Merino D, Sánchez-Arévalo Morato S, Dixon M, Pardo Ríos M, Juguera Rodríguez L. Self-extraction with and without a cervical collar: a biomechanical simulation study. Emergencias 2019; 31:36-38. [PMID: 30656871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To compare self-extraction with and without a cervical collar in subjects at low risk of cervical spine injuries. MATERIAL AND METHODS Simulation study analyzing biomechanical data from inertial sensors to detect misalignment of the cervical spine during self-extraction with and without a cervical collar. RESULTS Misalignment was a mean (SD) 3.12 (34.62) degrees greater during self-extraction with a Stiffneck collar in place (95% CI, -15.33 to 21.57 degrees; P=.7234) than during extraction without a collar. Misalignment was also greater, by 5.95 (31.76) degrees, with an X-collar in place (95% CI, -10.98 to 22.87; P=.4654) than without a collar. The between-collar comparison of differences showed that misalignment was 2.83 (12.10) degrees greater with the X-collar (95% CI, -3.62 to 9.27 degrees; P=.3650). CONCLUSION Misalignment of the cervical spinal column is similar during self-extraction with or without a cervical collar in place.
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Affiliation(s)
| | | | | | | | - Carmen Carazo Díaz
- Applied Statistical Methods in Medical Research Group, UCAM, Murcia, España
| | - David Prieto Merino
- Applied Statistical Methods in Medical Research Group, UCAM, Murcia, España. Faculty of Epidemiology and Population Health, London School of Hygiene Tropical Medicine, Londres, Reino Unido
| | - Silvia Sánchez-Arévalo Morato
- Servicio de Especialidades Quirúrgicas, Hospital Severo Ochoa, Leganés, Madrid. Autora del Blog Creative Nurse, España
| | - Mark Dixon
- Senior Lecturer, Course Director Paramedic Studies. Graduate Entry Medical School, University of Limerick, Irlanda
| | - Manuel Pardo Ríos
- Gerencia de Urgencias y Emergencias 061 de la Región de Murcia, España. Análisis Tridimensional de Reconocimiento Corporal, España
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Karikari I, Ghogawala Z, Ropper AE, Yavin D, Gabr M, Goodwin CR, Abd-El-Barr M, Veeravagu A, Wang MC. Utility of Cervical Collars Following Cervical Fusion Surgery. Does It Improve Fusion Rates or Outcomes? A Systematic Review. World Neurosurg 2018; 124:S1878-8750(18)32889-4. [PMID: 30593959 DOI: 10.1016/j.wneu.2018.12.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 12/06/2018] [Accepted: 12/07/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND The use of postoperative cervical collars following cervical fusions is common practice. Its use has been purported to improve fusion rates and outcomes. There is a paucity in the strength of evidence to support its clinical benefit. Our objective is to critically evaluate the published literature to determine the strength of evidence supporting the use of postoperative cervical collar use following cervical fusions. METHODS A systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (also known as PRISMA) was performed. An online search using Medline and Cochrane Central Register of Controlled Trials databases was used to query prospective and retrospective clinical trials evaluating cervical fusions with or without postoperative collar. RESULTS The search identified 894 articles in Medline and 65 articles in the Cochrane database. From these articles, 130 were selected based on procedure and collar use. Only 3 studies directly compared between collar use and no collar use. Our analysis of the mean improvement in neck disability index scores and improvement over time intervals did not show a statistically significant difference between collar versus no collar (P = 0.86). CONCLUSIONS We found no strong evidence to support the use of cervical collars after 1- and 2-level anterior cervical discectomy and fusion procedures, and no studies comparing collar use and no collar use after posterior cervical fusions. Given the cost and likely impact of collar use on driving and the return to work, our study shows that currently there is no proven benefit to routine use of postoperative cervical collar in patients undergoing 1- and 2-level anterior cervical discectomy and fusion for degenerative cervical pathologies.
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Affiliation(s)
- Isaac Karikari
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
| | - Zoher Ghogawala
- Division of Neurosurgery, Yale New Haven Hospital, New Haven, Connecticut, USA
| | - Alexander E Ropper
- Division of Neurosurgery, Baylor St. Luke's Medical Center, Houston, Texas, USA
| | - Daniel Yavin
- Division of Neurosurgery, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Mostafa Gabr
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - C Rory Goodwin
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Muhammad Abd-El-Barr
- Division of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Anand Veeravagu
- Division of Neurosurgery, Stanford University Medical Center, Stanford, California, USA
| | - Marjorie C Wang
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Veiga JRS, Mitchell K. Cervical spine clearance in the adult obtunded blunt trauma patient: A systematic review. Intensive Crit Care Nurs 2018; 51:57-63. [PMID: 30509691 DOI: 10.1016/j.iccn.2018.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 10/02/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND A missed cervical spinal injury could have devastating consequences. Patients with a suspected cervical spinal injury are kept in rigid collars for cervical immobilisation. Prolonged collar use has important clinical implications. A well-defined guideline related to the removal of cervical collars from adult obtunded blunt trauma patients has not been developed. AIM We sought to determine if Magnetic Resonance Imaging offered a definitive benefit over Computer Tomography with respect to patient management. METHOD We searched Ovid Online, EBSCO, NICE Evidence Journals, Medline, PubMED, BNI, CINAHL and Google Scholar as well as the grey literature. Data extraction and synthesis were performed on studies that compared the radiologic findings and clinical outcomes of Computer Tomography scan and Magnetic Resonance Imaging in this patient group. RESULTS There is evidence that supports the safe discontinuation of cervical collar use after a negative multidetector Computer Tomography scan result alone. Magnetic Resonance Imaging may detect a significant number of ligamentous injuries, but such injuries are rarely of clinical significance because they rarely alter clinical management. Its use should be limited to specific circumstances. CONCLUSION It is important for institutions to re-examine the latest evidence regarding cervical spinal clearance in order to update their guidelines.
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Affiliation(s)
| | - Kay Mitchell
- Integrative Physiology and Critical Illness Group, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK; Critical Care Research Group, Southampton NIHR Biomedical Research Centre, University Hospital Southampton, Southampton, UK
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Özdoğan S, Gökçek Ö, Katırcı Y, Çorbacıoğlu ŞK, Emektar E, Çevik Y. The effects of spinal immobilization at 20° on intracranial pressure. Am J Emerg Med 2019; 37:1327-30. [PMID: 30327158 DOI: 10.1016/j.ajem.2018.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Accepted: 10/10/2018] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE In this study, it was aimed to evaluate whether spinal immobilization at 20°, instead of the traditional 0°, affects intracranial pressure (ICP) via the ultrasonographic (USG) measurement of optic nerve sheath diameter (ONSD). METHODS 140 healthy, adult, non-smoking volunteers who had no acute or chronic diseases were included this study. Volunteers were randomly divided into two groups; performed spinal immobilization at 0° (Group 1) and at 20° (Group 2). After spinal immobilization (at 0 or 20°), measurements of ONSD were performed at 0, 30, and 60 min in an immobilized position. RESULTS When evaluating the change in ONSD over time (at 30 and 60 min) as compared to basal measurements at 0 min, it was found that the ONSD values of both sides (the right and left eyes) were significantly increased in Group 1 and Group 2. For Groups 1 and 2, these differences existed both between 0 and 30 min and between 30 and 60 min. In addition, in this study, the amounts of increase in the ONSD measurements from 0 to 30 min and from 30 to 60 min (ΔONSD0-30 min and ΔONSD30-60 min) in both groups were compared. The results showed that there was no significant difference between Group 1 and Group 2 in terms of ΔONSD measurements. CONCLUSIONS Spinal immobilization at 0° as a part of routine trauma management increased ONSD and thus ICP. Secondly, we found that similar to immobilization at 0°, spinal immobilization at 20° increased ONSD.
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Yuk M, Yeo W, Lee K, Ko J, Park T. Cervical collar makes difficult airway: a simulation study using the LEMON criteria. Clin Exp Emerg Med 2018; 5:22-28. [PMID: 29618189 PMCID: PMC5891742 DOI: 10.15441/ceem.16.185] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/06/2018] [Accepted: 02/14/2018] [Indexed: 11/30/2022] Open
Abstract
Objective Endotracheal intubation is extremely difficult to perform in patients wearing a cervical collar for a head and neck injury. Therefore, we analyzed actual measurements using the look externally, evaluate 3-3-2, Mallampati score, obstruction, and neck mobility (LEMON) criteria before and after cervical collar application to investigate the causes of a difficult airway. Methods This simulation study was performed in 76 healthy volunteers. We measured the mouth opening, modified Mallampati classification, and neck extension before and after cervical collar application. Results The mean inter-incisor distance significantly decreased from 4.3 to 2.6 cm (P<0.001). Fifty-seven participants classified as I and II were newly classified as III and IV according to the modified Mallampati classification after cervical collar application (16% to 91%). The angles of neck extension significantly decreased from 44° to 22° after cervical collar application (P<0.001). Before cervical collar application, our simulations predicted that 14 of 76 participants (18%) would have a difficult airway, whereas after cervical collar application, 76 of 76 (100%) were predicted to have a difficult airway. Conclusion All values for the LEMON criteria (mouth opening, modified Mallampati classification, and neck extension) worsened significantly after cervical collar application. Additionally, a difficult airway was predicted in all participants after cervical collar application.
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Affiliation(s)
- Moonsu Yuk
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Woonhyung Yeo
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Kangeui Lee
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Jungin Ko
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Taejin Park
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
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20
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Woster CM, Zwank MD, Pasquarella JR, Wewerka SS, Anderson JP, Greupner JT, Motalib S. Placement of a cervical collar increases the optic nerve sheath diameter in healthy adults. Am J Emerg Med 2017; 36:430-434. [PMID: 28865838 DOI: 10.1016/j.ajem.2017.08.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 08/23/2017] [Accepted: 08/23/2017] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Blunt head trauma is a common cause of increased intracranial pressure (ICP). Ultrasound measurement of the optic nerve sheath diameter (OSND) is an accurate and non-invasive way to detect increased ICP. Blunt trauma patients are often immobilized in a rigid cervical spine collar. Our objective was to describe the changes in ONSD following the placement of a c-collar and determine if any changes were time-dependent. METHODS We performed a prospective cohort study measuring the ONSD of healthy volunteers before and after placement of a c-collar. Two physicians obtained the measurements. Each eye was scanned twice using a standardized technique. This was done before c-collar placement, 5min after placement and 20min after placement. A mean of both eyes was calculated and analyzed using descriptive statistics. An intraclass correlation coefficient (ICC) was used to assess inter-rater reliability. RESULTS Twenty study participants with a mean age of 37.1years old were enrolled. The mean baseline ONSD was 3.77mm (95% CI 3.48-4.07). The mean ONSD 5 min after the c-collar was placed was 4.47 (95% CI 4.17-4.78). The mean ONSD at 20min after c-collar placement was 4.53 (95% CI 4.13-4.92). These changes were statistically significant (p=0.003 and <0.001). Reliability was relatively strong overall (ICC=0.74; 95% CI: 0.65, 0.81). CONCLUSION The placement of a cervical collar increased the ONSD at 5min and this change remained increased at 20min. Future study should assess whether similar results are found in patients with blunt head trauma.
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Affiliation(s)
- Casey M Woster
- Regions Hospital Department of Emergency Medicine, United States.
| | - Michael D Zwank
- Regions Hospital Department of Emergency Medicine, United States
| | | | - Sandi S Wewerka
- Regions Hospital Department of Emergency Medicine, United States
| | | | | | - Sakib Motalib
- Georgetown University Hospital, Washington Hospital Center, United States
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Kreinest M, Goller S, Gliwitzky B, Grützner PA, Küffer M, Häske D, Papathanassiou V, Münzberg M. Expertise of German paramedics concerning the prehospital treatment of patients with spinal trauma. Eur J Trauma Emerg Surg 2017; 43:371-6. [PMID: 27173645 DOI: 10.1007/s00068-016-0682-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 05/02/2016] [Indexed: 01/21/2023]
Abstract
PURPOSE Spinal immobilization is a standard procedure in emergency medicine. Increasing awareness of complications associated with immobilization of trauma patients leads to controversial discussions in the literature. Current guidelines require to include considerations of accident mechanism, an assessment of the patient's condition and an examination of the spine in the decision-making process if immobilization of the spine should be performed. This requires sound knowledge of assessing these parameters. The aim of the current study is to analyze German paramedics' subjective uncertainty in terms of their prehospital assessment and treatment of patients suffering from spine injuries. METHODS Over a period of 17 months participants in a trauma course were asked to complete a standardized anonymous questionnaire about subjective uncertainty of prehospital assessment and management of spinal trauma before participation in that course. Questions about the frequency of application of different immobilization tools and skills training on spinal immobilization were also asked. RESULTS A total of 465 paramedics were surveyed. The participants did not indicate any uncertainty about the prehospital diagnosis and treatment of spinal injuries. The feeling of confidence was significantly greater in participants who had already attended another course on structured trauma care before. The participants agreed with the statements that standardized algorithms facilitate teamwork and that there is a need for a protocol for the prehospital treatment of spinal injuries. CONCLUSIONS Paramedics do not feel uncertain about the prehospital assessment and treatment of spinal injuries. The feeling of confidence in participants who had already attended a course on the treatment of trauma patients before was significantly higher.
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Ala A, Shams-Vahdati S, Taghizadieh A, Miri SH, Kazemi N, Hodjati SR, Jalilzadeh-Binazar M. Cervical collar effect on pulmonary volumes in patients with trauma. Eur J Trauma Emerg Surg 2016; 42:657-60. [PMID: 26335538 DOI: 10.1007/s00068-015-0565-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 08/18/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION According to Advanced Trauma Life Support (ATLS) for trauma patients, a cervical collar should be applied initially. Patients on backboards with a cervical collar mostly complain of dyspnea and tend to take the collar off or roll themselves off the backboard. The purpose of this study is to investigate the effect of collar removal on lung volumes and dyspnea in patients with GCS 15. METHOD In a physiological study, 50 trauma patients with a GCS of 15 were enrolled. We measured lung volumes before and after the application of a cervical collar in patients. RESULTS The average FEV1 in patients with and without a cervical collar was 89.08 ± 17.59 (% of predicted) and 98.26 ± 17.74 (% of predicted), respectively. The average FEF25-75 in patients with a cervical collar was 90.80 ± 26.07 (% of predicted) and in patients without a cervical collar it was 101.90 ± 23.06 (% of predicted). The average FEV1/FVC in patients with a cervical collar was 95.30 ± 18.55 % and in patients without a cervical collar it was 99.14 ± 18.12 %. DISCUSSION The FEV1, FEV6, FEV1/FEV6, PEF, FEF25-75, FVC, FEV1/FVC parameters of pulmonary function tests were significantly increased after collar removal. CONCLUSION Cervical collar applications in trauma patients cause a significant decrease in lung capacity and spirometry parameters. Patients suffering from lung diseases and respiratory distress require special attention which means that the cervical collar should be removed as soon as cervical injuries are ruled out so as to avoid hypoxia.
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Jaisani MR, Pradhan L, Sagtani A. Use of cervical collar in temporomandibular dislocation. J Maxillofac Oral Surg 2015; 14:470-1. [PMID: 26028876 DOI: 10.1007/s12663-013-0505-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/18/2013] [Indexed: 11/29/2022] Open
Abstract
Dislocation of the temporomandibular joint represents 3 % of all reported dislocated joints. In the last 3 decades many cases of TMJ dislocation have been reported with a wide variety of treatment options ranging from non-surgical conservative approaches to open joint procedures. The question remains whether one method is superior to the others. Conservative treatments are still the option in this part of the continent due to financial constraints and as well as due to availability of skilled manpower. A variety of conservative techniques have been described for reducing dislocations, all of which require 10-14 days of immobilization of the jaw post reduction so as to prevent further episodes of dislocation. Immobilization of the jaw can be done in the form of barrel bandage, barton bandage, head chin cap or maxillomandibular fixation using arch bars. We suggest the use of a cervical collar as a form of post reduction immobilization technique to overcome the inherent disadvantages of conventional forms of immobilization techniques.
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Affiliation(s)
- Mehul R Jaisani
- Department of OMFS, College of Dental Surgery, B P Koirala Institute of Health Science, Dharan, Nepal
| | - Leeza Pradhan
- Department of OMFS, College of Dental Surgery, B P Koirala Institute of Health Science, Dharan, Nepal
| | - Alok Sagtani
- Department of OMFS, College of Dental Surgery, B P Koirala Institute of Health Science, Dharan, Nepal
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Chhabra S, Chhabra N, Gupta P Jr. Recurrent Mandibular Dislocation in Geriatric Patients: Treatment and Prevention by a Simple and Non-invasive Technique. J Maxillofac Oral Surg 2015; 14:231-4. [PMID: 25838702 DOI: 10.1007/s12663-012-0454-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Accepted: 10/03/2012] [Indexed: 10/27/2022] Open
Abstract
Dislocation is defined as the complete loss of articular relationship between the articular fossa of the temporal bone and the condyle-disk complex. Most common aetiology of dislocation is wide mouth opening, trauma and use of certain drugs. It is classified as acute, chronic and recurrent. Chronic recurrent dislocation of mandible is a distressing condition especially for geriatric patients. Various non-surgical methods of reduction include Hippocratic method, Awang's gag reflex method, wrist-pivot technique, combined ipsilateral staggering technique, recumbent approach, intermaxillary fixation, injection of a sclerosing solution, autologus blood transfusion and botulinum toxin. In geriatric population, the ridges become atrophic with time and use of any method of reduction which exerts force on mandible increases chances of fracture of mandible. Awang's gag reflex method is a non invasive technique which helps in treatment of chronic recurrent dislocation in geriatric patients. Along with this technique the use of a cervical collar has been reported in this article, which not only acts as a restrainer but also is helpful for cervical spondylosis, a common condition encountered in geriatric population.
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