Evaluating Cervical Collar Protocols

Cervical Collars: Soft, Firm, and Hard

Cervical collars are broadly categorized into three types: soft, firm, and hard. Personally, I consider the soft ones to be more like scarves. When I see people wearing them while moving around, I often think they don't have a serious problem or just need a sick leave. However, the firm and hard collars are genuinely helpful for various cervical issues.

During my stay in Europe, I discussed the use of cervical collars after anterior cervical procedures. Here, we tend to keep patients in collars for three or more months after ACDF. However, my European colleagues disagree with this approach. Whether they used bone or prosthetic materials, with or without plating, they don't keep patients in collars and often discharge them the same day if everything is good. They have strong evidence supporting this practice.

On the other hand, our approach of keeping patients in collars is also evidence-based with variation in timing. Beyond the evidence, the psychological impact on a patient undergoing definitive surgery and still being required to wear a collar for three months is often underestimated and needs proper assessment.

Recently, I have tried not using neck collars for some of my patients. I did encounter one complication with graft extrusion on the third post-op day, but four of my patients are doing fine two weeks post-surgery. The scarce availability and rising cost of hard neck collars are prompting me to follow my colleagues' suggestions. It seems to be working if we insert the appropriately sized graft. We'll see if any complications arise and how the fusion progresses in the near future.

Please note that this is my personal opinion. I haven't conducted in-depth research on this, and my conclusions might be premature. However, sometimes we need to think differently if it benefits our patients in various ways.

Expert opinions are most welcome!