Why we need to rethink C-spine immobilization: we need to reevaluate current practices and develop a saner cervical policy.

Abstract

T he spinal immobilization of trauma patients suspected of having spinal injury has been a cornerstone of prehospital care for decades. Current practices are based on the belief that a patient with an injured spinal column can deteriorate neurologically without immobilization. This concern has ballooned to include large numbers of patients with little or no chance of such an injury and caregivers with little appreciation for the complications caused by use of the cervical collar and spinal board. Somewhere between 1 million and 5 million patients receive spinal immobilization each year in the United States.1,2 The injury of concern is not the cervical spine fracture but the unstable cervical fracture with the potential for further neurological deficits.3 It is clear that among severely traumatized patients admitted to hospitals, the rate of cervical spine fractures is 2%–5% and the rate of unstable cervical fractures is 1%–2%.4–6 For patients with head injuries, the rate of cervical spine injuries increases substantially.7 Among patients with known unstable cervical spine fractures, half in one study demonstrated neurological deficits upon hospital arrival.8 Most clinicians would agree that this high-risk group would benefit from spinal immobilization, and we are truly concerned about that 0.5%–1% with unstable cervical spine fractures and intact spinal cords. It is logical that among patients with lesser mechanisms of injury, the | By Karl A. Sporer, MD, FACEP, FACP

Cite this paper

@article{Sporer2012WhyWN, title={Why we need to rethink C-spine immobilization: we need to reevaluate current practices and develop a saner cervical policy.}, author={Karl A. Sporer}, journal={EMS world}, year={2012}, volume={41 11}, pages={74-6} }