PROSPECTIVE EVALUATION OF CRANIOFACIAL PRESSURE IN 4 DIFFERENT CERVICAL ORTHOSES

Introduction: Cervical collars play a role in the long-term treatment of cervical spine injuries. Pressure ulcers are one of the potential c omplications. We previously reported on three patients who developed p ressure ulcers of the scalp while wearing cervical collars. The pressu re exerted by different collars was measured to determine whether this was a significant factor in the clinical problem we observed. Methods : Four brands of cervical collars (Stifneck, Philadelphia, Newport, an d Miami J) were tested in 20 normal volunteers. Pressure was measured at the occiput, mandible, and chin. Opinions on comfort were also coll ected. Results: The Stifneck collar exceeds capillary closing pressure (CCP) for most contact points. The Philadelphia collar exposes the we arer to high pressures when supine compared with the upright position (p < 0.001). The Newport and Miami J collars exerted pressure well bel ow CCP. The subjective comfort (scale from 0 (poor) to 5 (best)) ratin gs were: Stifneck = 0.85, Philadelphia = 3.00, Newport = 3.80, and Mia mi J = 3.45. Conclusions: We recommend use of ''patient-friendly'' col lars such as the Newport or Miami J because of their favorable skin pr essure patterns and superior patient comfort. These collars should pot entially reduce the incidence of soft-tissue complications and improve patient compliance.