Clinical Review Lesson of the week

Exacerbating cervical spine injury by applying a hard collar

BMJ 1999; 319 doi: https://doi.org/10.1136/bmj.319.7203.171 (Published 17 July 1999) Cite this as: BMJ 1999;319:171
  1. Marios C Papadopoulos, registrar,
  2. Aabir Chakraborty, senior house officer,
  3. Georgina Waldron, senior house officer,
  4. B Anthony Bell, professor
  1. Department of Neurosurgery, Atkinson Morley's Hospital, London SW20 0NE
  1. Correspondence to: Professor Bell
  • Accepted 3 December 1998

Hard collars should not be used for patients with fixed cervical kyphosis who break their neck.

Neck immobilisation is vital in patients with suspected cervical spine injuries and generally involves applying a hard cervical collar—usually by ambulance crew, nurses, or junior doctors. We present the case of a patient with ankylosing spondylitis who sustained a cervical fracture but had no cord injury initially. He became quadriplegic after a hard collar was applied in the emergency department, and he subsequently died.

Case report

An 82 year old man fell down some stairs. He walked into the emergency department, without cervical immobilisation, complaining of neck pain. He had longstanding spinal stiffness and, because of a fixed flexion deformity of his neck, his line of vision was only a few paces ahead. There was tenderness over the spinous processes of C6 and C7, but no neurological abnormality in his limbs or sphincter disturbance were noted. Radiographs of the cervical spine showed ossification across the intervertebral discs at several levels, suggesting ankylosing spondylitis, and …

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