Spinal Motion Restriction

Spinal immobilization with a backboard and cervical collar for patients with suspected spine injury became common practice in the 1960s. The increase in automobile accidents drove this decision as automobiles became more commonplace, and a position paper was published by the American Academy of Orthopedics endorsing its use without evidence that spinal immobilization improved outcomes. Spinal immobilization included a cervical collar and a rigid backboard with secured straps. Recent studies assessing the validity of spinal immobilization raised concern for harm instead of better outcomes). In the early 2010s, the common practice moved to spinal motion restriction to replace the common use of spinal immobilization. In 2019, a retrospective observational study from the University of Arizona showed no significant increase in spinal cord injury after transitioning from a spinal immobilization protocol to 1 of spinal motion restrictions.

Indications

A joint position paper between the American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), and the National Association of Emergency Medicine Physicians (NAEMSP) in 2018 outlined the uniform recommendations for spinal motion restriction in the care of trauma patients. The indications for patients who have experienced blunt trauma are summarized in the table (see Table. Indications for Spinal Motion Restriction). Patients with none of the identified indications should not undergo spinal motion restriction due to the potential for harm by being placed in a cervical collar or backboard. In the pediatric population, there is no indication based on age alone for using spinal motion restriction. Young patients can present a challenge to providers due to communication issues. A retrospective review completed by Hale et al of 2,972 pre-elementary trauma patients showed that CT scans were not necessary for patients less than 5 years old without clinical findings on the exam. In addition to the criteria listed in the table, torticollis indicates spinal motion restriction (particularly cervical collar placement) in pediatric patients.