# Exercising Increased Caution Before Removing C-collars in Altered Patients and Patients With Chronic Cervical Spine Changes: Reports of Neurological Deficit or Injury Following C-collar Removal Despite Normal Imaging

## TL;DR

This paper highlights the risks of removing cervical collars in patients with altered mental states or chronic neck issues, even if imaging appears normal.

## Contribution

The paper introduces cautionary cases and recommendations for C-collar removal in patients with dementia or chronic cervical spine changes.

## Key findings

- Two patients with chronic cervical spine changes and altered mental states developed complications after C-collar removal.
- One patient experienced neurological deficits following C-collar removal despite normal initial imaging.
- The paper suggests increased caution for C-collar removal in patients with dementia or chronic degenerative cervical spine changes.

## Abstract

Removing a cervical collar (C-collar) in trauma patients is a clinically complex and often controversial subject; existing guidelines have some areas of ambiguity. Little to no literature exists regarding C-collar removal in patients with chronic degenerative changes of the cervical spine or dementia. We present two trauma patients who were initially cleared of their C-collars after undergoing a cervical spine CT scan. Both patients later required their C-collars to be replaced and required neurosurgical consultation; one patient developed neurological deficits. Both patients were mentally altered in some form; one via intoxication and the other via existing dementia. Additionally, both patients had chronic degenerative cervical spine changes. While adverse outcomes following C-collar removal are rarely recorded in the literature, this is likely due to underreporting. In the absence of literature specific to chronic degenerative changes or dementia, we recommend that clinicians exercise increased caution when removing C-collars in this patient population.