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 The spinal cord is a long, thin, tubular structure made up of nervous tissue, which extends from the medulla oblongata in the brainstem to the lumbar region of the vertebral column (backbone). The backbone encloses the central canal of the spi ...

. It is estimated that 2% of people with

blunt trauma Blunt trauma, also known as blunt force trauma or non-penetrating trauma, is physical traumas, and particularly in the elderly who fall. It is contrasted with penetrating trauma which occurs when an object pierces the skin and enters a tissue ...

will have a spine injury.

Uses

Spinal immobilization was historically used routinely for people who had experienced physical trauma. There is; however, little evidence for its routine use.

Long spine board A spinal board, is a patient handling device used primarily in pre-hospital trauma (medicine), trauma care. It is designed to provide rigid support during movement of a person with suspected spinal or limb injuries. They are most commonly used b ...

s 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 The American College of Surgeons is an educational association of surgeons created in 1913.American College of Surgeons Online "What is the American College of Surgeons?"/ref> See also *American College of Physicians The American College o ...

recommend its use only in those at high risk. This includes: those with blunt trauma who have a

decreased level of consciousness An altered level of consciousness is any measure of arousal other than normal. Level of consciousness (LOC) is a measurement of a person's arousability and responsiveness to stimuli from the environment. A mildly depressed level of consciousne ...

, 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.

Neck

There is little high quality evidence for spinal motion stabilization of the neck before arrival at a hospital. Using a

hard cervical collar A cervical collar, also known as a neck brace, is a medical device used to support and immobilize a person's neck. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, and can be used to treat chronic m ...

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 Intubation (sometimes entubation) is a medical procedure involving the insertion of a tube into the body. Patients are generally anesthetized beforehand. Examples include tracheal intubation, and the balloon tamponade with a Sengstaken-Blakemo ...

is required the cervical collar should be removed and inline stabilization provided.

Mid and low back

Spinal motion stabilization is not supported for penetrating trauma to back including that caused by gun shot wounds.

Cervical spine clearance

The_Canadian_C-spine_rule_for_those_with_a_normal_Glasgow_coma_scale_and_who_are_otherwise_stable

Paramedics are able to accurately determine who needs or does not need neck immobilization based on an algorithm. There are two main algorithms, the

Canadian C-spine rule Clearing the cervical spine is the process by which medical professionals determine whether cervical spine injuries exist, mainly regarding cervical fracture. It is generally performed in cases of major trauma. This process can take place in the ...

and NEXUS. The Canadian C-spine rule appears to be better. However, following either rule is reasonable.

Side effects

Concern with use include: pain, agitation, and

pressure ulcer Pressure ulcers, also known as pressure sores, bed sores or pressure injuries, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combi ...

s. A systematic review found

cervical collar A cervical collar, also known as a neck brace, is a medical device used to support and immobilize a person's neck. It is also applied by emergency personnel to those who have had traumatic head or neck injuries, and can be used to treat chronic m ...

related skin ulcers from the devices in 7 to 38%. If a longboard is used, cushioning it is useful to decrease discomfort due to pressure. A

vacuum mattress A vacuum mattress, or vacmat, is a medical device used for the immobilisation of patients, especially in case of a vertebra, pelvis or limb trauma (especially for femur trauma). It is also used for manual transportation of patients for short dist ...

and scoop board typically results in lower pressures.

Mechanism of action

Studies with volunteers have found that using a hard collar, head stabilization with rolled up towels, and a long board decrease movement of the board. What impact this has is unclear.

References

{{Trauma First aid Injuries Vertebral column disorders