Prospective evaluation of craniofacial pressure in four different cervical orthoses

Cervical collars play a role in the long-term treatment of cervical spine injuries. Pressure ulcers are one of the potential complications. We previously reported on three patients who developed pressure ulcers of the scalp while wearing cervical collars. The pressure exerted by different collars was measured to determine whether this was a significant factor in the clinical problem we observed.

Four brands of cervical collars (Stifneck, Philadelphia, Newport, and Miami J) were tested in 20 normal volunteers. Pressure was measured at the occiput, mandible, and chin. Opinions on comfort were also collected.

The Stifneck collar exceeds capillary closing pressure (CCP) for most contact points. The Philadelphia collar exposes the wearer to high pressures when supine compared with the upright position (p < 0.001). The Newport and Miami J collars exerted pressure well below CCP. The subjective comfort (scale from 0 (poor) to 5 (best)) ratings were: Stifneck = 0.85, Philadelphia = 3.00, Newport = 3.80, and Miami J = 3.45.

We recommend use of "patient-friendly" collars such as the Newport or Miami J because of their favorable skin pressure patterns and superior patient comfort. These collars should potentially reduce the incidence of soft-tissue complications and improve patient compliance.