• Luca Ricciardi, Vito Stifano, Sonia D'Arrigo, Filippo Maria Polli, Alessandro Olivi, and Carmelo Lucio Sturiale.
• Departments of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli - IRCCS, Rome, Italy. ricciardi.lu@gmail.com.
• Eur Spine J. 2019 Aug 1; 28 (8): 1821-1828.

PurposeWhiplash injury (WI) represents a common diagnosis at every emergency department. Several investigations have been conducted to compare the different medical managements for non-surgical cases. However, the role of the immobilization with a non-rigid cervical collar (nRCC) for pain management and range of motion (RoM) preservation has not been completely clarified.MethodsWe performed a systematic review of the randomized control trials (RCTs) and a pooled analysis in order to investigate the role of the nRCC for pain management, scored through the visual analogue scale (VAS) and the RoM, by comparing the use of a nRCC (for 1-2 weeks) with a non-immobilization protocols, regardless of the association with physical therapy (PhT). Only patients with whiplash-associated disorders grade I-II were included. Due to a certain heterogeneity across the RCTs, follow-up period time range resetting was necessary in order to pool the data.ResultsA total of 141 papers were reviewed; 6 of them matched the inclusion criteria and were admitted to the final study. Pooled analysis showed that nRCC does not improve the outcome in terms of VAS score and RoM trends along the follow-up. Moreover, VAS and RoM trends seem to further improve at long-term follow-up in non-immobilization associated with PhT group.ConclusionsThis pooled analysis of the available RCTs shows the absence of an advantage of the immobilization protocol with a nRCC after a WI. On the contrary, non-immobilization protocols show an overall better trend of pain relief and neck mobility recovery, regardless of the association of PhT. These slides can be retrieved under Electronic Supplementary Material.

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