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Extrication Collars Can Result in Abnormal Separation Between Vertebrae in the Presence of a Dissociative Injury

Ben-Galim, Peleg MD; Dreiangel, Niv MD; Mattox, Kenneth L. MD; Reitman, Charles A. MD; Kalantar, S. Babak MD; Hipp, John A. PhD

The Journal of Trauma: Injury, Infection, and Critical Care: August 2010 - Volume 69 - Issue 2 - p 447-450
doi: 10.1097/TA.0b013e3181be785a
Original Article

Background: Cervical collars are applied to millions of trauma victims with the intent of protecting against secondary spine injuries. Adverse clinical outcomes during the management of trauma patients led to the hypothesis that extrication collars may be harmful in some cases. The literature provides indirect support for this observation. The purpose of this study was to directly evaluate cervical biomechanics after application of a cervical collar in the presence of severe neck injury.

Methods: Cranial-caudal displacements in the upper cervical spine were measured in cadavers from images taken before and after application of collars following creation of an unstable upper cervical spine injury.

Results: In the presence of severe injury, collar application resulted in 7.3 mm ± 4.0 mm of separation between C1 and C2 in a cadaver model. In general, collars had the effect of pushing the head away from the shoulders.

Conclusions: This study was consistent with previous evidence that extrication collars can result in abnormal distraction within the upper cervical spine in the presence of a severe injury. These observations support the need to prioritize additional research to better understand the risks and benefits of cervical stabilization methods and to determine whether improved stabilization methods can help to avoid potentially harmful displacements between vertebrae.

From the Spine Research Laboratory, Baylor College of Medicine, Houston, Texas.

Submitted for publication May 4, 2009.

Accepted for publication August 27, 2009.

Supported by the Department of Orthopedic Surgery and by the Benjamin Ford Kitchen Professorship in Orthopedic Surgery.

Address for reprints: John A. Hipp, PhD, Baylor College of Medicine, 1709 Dryden, 12th floor, Houston, TX 77030; email:

© 2010 Lippincott Williams & Wilkins, Inc.