Positioning for immobilization after cervical injury – adapted from the Annals of Emergency Medicine 1996;28:351-3 – Tips from Other Journals
Nearly one-half of all spinal injuries occur in motor vehicle accidents, with falls, sports injuries and assaults comprising the remainder. One-half of all spinal injuries occur in the cervical region, with associated risks of quadriplegia. Patients with suspected cervical injury must be immobilized rapidly and properly. Immobilization is thought to prevent further damage to the spinal cord. Most authorities favor immobilization in a “neutral” position. Defining this neutral position has been difficult. De Lorenzo and associates attempted to formulate a clinical definition of optimal cervical spine position that would enhance the relationship of the spinal canal and spinal cord dimensions.
Nineteen healthy volunteers were placed in a variety of head and neck positions representing cervical spine immobilization. Magnetic resonance imaging (MRI) was performed. Ratios of spinal canal and spinal cord cross-sectional areas were determined, with smaller ratios representing a greater risk of further injury to a spinal cord that may be swollen as a result of injury or ischemia or that may be impinged on by displaced vertebral structures.
The findings determined a most favorable position based on internal anatomy and defined this position by external anatomic parameters, establishing a benchmark for optimal cervical spine immobilization. Benefit accrued from slight flexion (2 cm of occiput elevation) at the C5 level. This flexion can be accomplished by occipital padding.
The authors conclude that degrees of static flexion or extension greater or less than 4 cm from the plane of the back produce variable spinal canal/spinal cord relationships that might result in further damage to the cord.
In a related editorial, Schriger questions the sample size and the use of ratios of spinal cord and spinal canal dimensions as the crucial determinant of neurologic outcome. Schriger proposes that an optimal position may not exist because of dependence on the type of injury, body habitue and other factors. The appropriate broader issue may be keeping the patient comfortable and enhancing transport and patient compliance, preventing further damage to the cord.
De Lorenzo RA, et al. Optimal positioning for cervical immobilization. Ann Emerg Med 1996;28:301-8, and Schriger DL. Immobilizing the cervical spine in trauma: should we seek an optimal position or an adequate one? [Editorial!. Ann Emerg Med 1996;28:351-3.
COPYRIGHT 1996 American Academy of Family Physicians
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