how to clear cervical collar

Therefore, the appropriate next step is to attempt to clear his cervical spine clinically and remove the collar.

Clinical clearance of the cervical spine is predicated on three conditions: (1) the mechanism of injury is not one with a high risk of developing cervical spine injury, (2) the patient was not intoxicated or impaired at the time of the injury, and (3) the patient can cooperate with the examination and report pain. In patients who have a low-risk mechanism of injury, a normal spine CT scan, and the ability to cooperate with the examination, clinical clearance is appropriate. The evaluation consists of removing the anterior part of the collar and asking the patient to flex and extend the neck and rotate the head from side to side without resistance. If there is no restriction of movement or pain, the motions are repeated against mild resistance (with a hand). If there is no pain to resistance, the neck can be considered cleared and the collar removed.

In patients in whom the clinical clearance fails and in those who are not able to cooperate with the examination or who have a more severe mechanism (such as a fall from height or a severe motor vehicle crash), there is controversy over the appropriate management. Three options have been entertained. The most conservative option is to leave the patient in a collar for 6 weeks and reevaluate. This was thought to be the safest option, but recognition that skin breakdown around the collar is a serious complication has called this into question. The second option is to perform MRI of the cervical spine to investigate ligamentous injury that could make the spine unstable without bony injury. Clearance based on MRI testing has not been evaluated rigorously but is practiced extensively. The final option is to clear the spine with only CT scanning evidence. Because the risk of ligamentous injury is low if there are no findings of soft-tissue swelling on CT scans, this option is defensible but relies on a degree of comfort with the uncertainty that a small proportion of patients with unstable spines may be missed. This third option is gaining acceptance in medical cultures around the world.12

Footnotes

  1. SEEK Questionnaires ↩

  2. Moeri M, Rothenfluh DA, Laux CJ, et al. Cervical spine clearance after blunt trauma: current state of the art. EFORT Open Rev. 2020;5(4):253-259. PubMed ↩