Interdisciplinary Neurosurgery (Sep 2023)
In healthy volunteers the Miami-J® cervical collar causes swallow dysfunction. This may increase the risk of aspiration; of particular potential consequence in older people with neck injury
Abstract
Background: In young healthy volunteers a cervical hard collar has been shown to change swallowing physiology. The risk of aspiration pneumonia increases with age. Methods: In this open prospective dual-arm controlled trial without randomisation there were 23 patients divided into two cohorts: 11 older (mean age 84) and 12 younger (mean age 25).A series of video fluoroscopy (VF) swallow studies were performed without a cervical collar, followed by the same series of VF with a Miami-J® cervical collar fitted. The Modified Barium Swallow Impairment Profile (MBSImPTM©) and Penetration-Aspiration Scale (PAS) were used to define and score swallow function and level of aspiration without and with the collar fitted. Results: An increase in the median MBSImPTM© score amongst all participants in the oral phase of swallow (p = 0.01) and combined oral and pharyngeal phase of swallow (p = 0.006) was seen when volunteers were fitted with the Miami-J® collar, compared to no collar.When wearing the collar deterioration in swallow function and small increases in PAS level were more marked in the older cohort, but these latter findings were not statistically significant. Conclusions: Cervical hard collars change swallowing physiology in younger and older volunteers. Whilst we did not measure a statistically significant difference in the PAS level pre- and post- collar wearing, we feel it is important to highlight these changes in swallowing physiology and speculate that with collar use there is a potential risk of aspiration associated with these changes.Potential risk of aspiration should be carefully balanced with the benefit gained from collar use in the management of cervical spine injury (both in conservative and postoperative management). Although this is a small study it is important to highlight an area of concern of particular importance in the older population who have physiological changes to the swallow that occur with age (presbyphagia) and where baseline risk of aspiration is higher.
