Do not move! Spinal immobilization or spinal motor restriction: the long-lasting debate from the Napoleonic Wars to 2024 SIMEU policy statement

Published: 27 June 2024
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The management of spinal trauma in the pre-hospital setting is based on techniques of immobilization for prevention of secondary neurological damage in high-risk patients during transportation.1 Since the ’70s, the traditional form of Preventive Spinal Immobilization (PSI) has been carried out using a long spinal board, head blocks, and immobilization straps often associated with the placement of a cervical collar.2 The first documentation of this practice comes from the early 19th century, when pre-hospital trauma care was introduced on the battlefields of the Napoleonic Wars.3 This strategy is still adopted by many pre-hospital medical services worldwide and taught as the gold standard on many trauma courses. The traditional form of PSI is indeed based more on pragmatism than on high-quality studies supporting its efficacy.3 [...]

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Citations

Stuke LE, Pons PT, Guy JS, et al. Pre-hospital spine immobilization for penetrating trauma— review and recommendations from the pre-hospital trauma life support executive committee. J Trauma 2011;71:763–9.
American Academy of Orthopaedic Surgeons. Committee on injuries. Emergency care and transportation of the sick and injured. Chicago, IL: The Academy; 1971.
Ten Brinke JG, Groen SR, Dehnad M, et al. Pre-hospital care of spinal injuries: a historical quest for reasoning and evidence. Eur Spine J 2018;27:2999-3006.
Kwan I, Bunn F. Effects of pre-hospital spinal immobilization: a systematic review of randomized trials on healthy subjects. Prehosp Disaster Med 2005;20:47-53.
Oosterwold JT, Sagel DC, Van Grunsven PM, et al The characteristics and pre-hospital management of blunt trauma patients with suspected spinal column injuries: a retrospective observational study. Eur J Trauma Emerg Surg 2017;43:513–24
Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury 1996;27:647-9.
Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia 2001;56:511-3.
Cordell WH, Hollingsworth JC, Olinger ML, et al. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med 1995;26:31-6.
Ham W, Schoonhoven L, Schuurmans MJ, Leenen LP. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. J Trauma Acute Care Surg 2014;76:1131-41.
Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehosp Emerg Care 1999;3:347-52.
Liao S, Schneider NRE, Hüttlin P, et al. Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction-A study in two new cadaveric trauma models. PLoS One 2018;13:e0195215.
Ms R, Riffelmann M, Kunze-Szikszay N, et al. Vacuum mattress or long spine board: which method of spinal stabilisation in trauma patients is more time consuming? A simulation study. Scand J Trauma Resusc Emerg Med 2021;29:46.
Stuby L, Thurre D. Time performance of scoop stretcher versus vacuum mattress for pre-hospital spinal stabilization: open-label simulation-based randomized controlled trial. Emerg Care J 2024;20:12226
Hawkridge K, Ahmed I, Ahmed Z. Evidence for the use of spinal collars in stabilising spinal injuries in the pre-hospital setting in trauma patients: a systematic review. Eur J Trauma Emerg Surg 2022;48:647-57.
Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma 2010;68:115-20; discussion 120-1.
Castro-Marin F, Gaither JB, Rice AD, et al. Pre-hospital protocols reducing long spinal board use are not associated with a change in incidence of spinal cord injury. Prehosp Emerg Care 2020;24:401-10.
Underbrink L, Dalton AT, Leonard J, et al. New immobilization guidelines change EMS critical thinking in older adults with spine trauma. Prehosp Emerg Care 2018;22:637-44.
Fischer PE, Perina DG, Delbridge TR, et al. Spinal motion restriction in the trauma patient - a joint position statement. Prehosp Emerg Care 2018;22:659-61.
Dixon M, O'Halloran J, Cummins NM. Biomechanical analysis of spinal immobilization during pre-hospital extrication: a proof of concept study. Emerg Med J 2014;31:745-9.
Häske D, Schier L, Weerts JON, et al. An explorative, biomechanical analysis of spine motion during out-of-hospital extrication procedures. Injury 2020;51:185-92.
Nutbeam T, Kehoe A, Fenwick R, et al. Do entrapment, injuries, outcomes and potential for self-extrication vary with age? A pre-specified analysis of the UK trauma registry (TARN). Scand J Trauma Resusc Emerg Med 2022;30:14.
Hawkins SC, Williams J, Bennett BL, et al. Wilderness medical society clinical practice guidelines for spinal cord protection: 2024 update. Wilderness Environ Med 2024;35:78S-93S.

How to Cite

Serra, S., Poggiali, E., Rugna, M., De Iaco, F., & Ghiadoni, L. (2024). Do not move! Spinal immobilization or spinal motor restriction: the long-lasting debate from the Napoleonic Wars to 2024 SIMEU policy statement. Emergency Care Journal, 20(2). https://doi.org/10.4081/ecj.2024.12745