Spinal precautions also known as spinal immobilization and spinal motion restriction are efforts to prevent movement of the spine in those with a risk of a spine injury. This is done as an effort to prevent injury to the spinal cord. It is estimated that 2% of people with blunt trauma will have a spine injury.
Spinal immobilization was historically used routinely for people who had experienced physical trauma. There is; however, little evidence for its routine use. Long spine boards are often used in the prehospital environment as part of spinal immobilization. Due to concerns of side effects the National Association of EMS Physicians and the American College of Surgeons recommend its use only in those at high risk. This includes: those with blunt trauma who have a decreased level of consciousness, pain or tenderness in the spine, those with numbness or weakness believed to be due to a spinal injury and those with a significant trauma mechanism that are intoxicated or have other major injuries. In those with a definite spinal cord injury immobilization is also recommended.
There is little high quality evidence for immobilization of the neck before arrival at a hospital. Using a hard cervical collar and attaching a person to an EMS stretcher may be sufficient in those who were walking after the accident or during long transports. In those with penetrating neck or head trauma spinal immobilization may increase the risk of death. If intubation is required the cervical collar should be removed and inline stabilization provided.
Mid and low back immobilization
Spinal immobilization is not supported for penetrating trauma to back including that caused by gun shot wounds.
Cervical spine clearance
Paramedics are able to accurately determine who needs or does not need neck immobilization based on an algorithms. There are two main algorithms, the Canadian C-spine rule and NEXUS. The Canadian C-spine rule appears to be better. However, following either rule is reasonable.
Mechanism of action
- Pollak, Andrew (1999). Refresher: Emergency Care and Transportation of the Sick and Injured. p. 302. ISBN 9780763709129.
- Ahn, H; Singh, J; Nathens, A; MacDonald, RD; Travers, A; Tallon, J; Fehlings, MG; Yee, A (August 2011). "Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines.". Journal of neurotrauma 28 (8): 1341–61. PMID 20175667.
- Oteir, AO; Smith, K; Jennings, PA; Stoelwinder, JU (August 2014). "The prehospital management of suspected spinal cord injury: an update.". Prehospital and disaster medicine 29 (4): 399–402. PMID 25046238.
- White CC, 4th; Domeier, RM; Millin, MG; Standards and Clinical Practice Committee, National Association of EMS, Physicians (Apr–Jun 2014). "EMS spinal precautions and the use of the long backboard - resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma.". Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors 18 (2): 306–14. doi:10.3109/10903127.2014.884197. PMID 24559236.
- Oteir, AO; Smith, K; Stoelwinder, JU; Middleton, J; Jennings, PA (12 January 2015). "Should suspected cervical spinal cord injury be immobilised?: A systematic review.". Injury. PMID 25624270.
- Sundstrøm, T; Asbjørnsen, H; Habiba, S; Sunde, GA; Wester, K (15 March 2014). "Prehospital use of cervical collars in trauma patients: a critical review.". Journal of neurotrauma 31 (6): 531–40. PMID 23962031.
- Stuke, LE; Pons, PT; Guy, JS; Chapleau, WP; Butler, FK; McSwain, NE (September 2011). "Prehospital spine immobilization for penetrating trauma--review and recommendations from the Prehospital Trauma Life Support Executive Committee.". The Journal of trauma 71 (3): 763–9; discussion 769–70. PMID 21909006.
- Michaleff, ZA; Maher, CG; Verhagen, AP; Rebbeck, T; Lin, CW (6 November 2012). "Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review.". CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 184 (16): E867–76. PMID 23048086.
- Ackland, H; Cameron, P (April 2012). "Cervical spine - assessment following trauma.". Australian family physician 41 (4): 196–201. PMID 22472679.
- Ham, W; Schoonhoven, L; Schuurmans, MJ; Leenen, LP (April 2014). "Pressure ulcers from spinal immobilization in trauma patients: a systematic review.". The journal of trauma and acute care surgery 76 (4): 1131–41. PMID 24662882.