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Cervical collars and intracranial pressure

Three Part Question

In [patients with a head injury requiring cervical spine immobilization] does [a correctly fitted cervical collar] increase [intracranial pressure]?

Clinical Scenario

A 26 year old man was brought to the emergency department by the paramedics after a road traffic accident. He was immobilized on a long spinal board and a correctly fitted collar was applied to his neck. The patient was unconscious. You wonder whether the cervical collar raises intracranial pressure in head injury patients.

Search Strategy

Medline 1966-10/2004 using the Ovid interface.
[({exp neck OR exp neck injuries OR exp cervical vertebrae OR} AND {exp braces OR brace$.mp OR collar$.mp}) OR cervical collar$.mp) AND {exp intracranial pressure OR intracranial pressure$.mp OR}]

Search Outcome

11 papers were found. A recent review article included all the relevant papers. This article is presented below.

Relevant Paper(s)

Author, date and country Patient group Study type (level of evidence) Outcomes Key results Study Weaknesses
Ho AM, et al.
Head Injured patients needing cervical spine immobilisation.Review articleChanges in ICP with application of cervical collarWith the exception of Kuhnigk et al, all papers showed a significant rise in ICP after application of cervical collar.No search strategy.


This study reviews all the evidence looking at this clinical question. Most studies have shown that a semi-rigid cervical collar causes a variable rise in intracranial pressure in most patients.

Editor Comment

Search redone in October 2004. New review article found.

Clinical Bottom Line

Correctly fitted cervical collars increase intracranial pressure. The clinical significance of this rise has not been established.

Level of Evidence

Level 1 - Recent well-done systematic review was considered or a study of high quality is available.


  1. Ho AM, Fung KY, Joynt GM, Karmakar MK, Peng Z. Rigid cervical collar and intracranial pressure of patients with severe head injury. Journal of Trauma-Injury Infection & Critical Care 2002;53(6):1185-8.