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Spinal motion restriction using a long spine board and cervical spine collar is implemented in the case of trauma, when certain criteria are met, to help reduce the chance of spinal cord injury. The indications for applying spinal motion restriction are a GCS of less than 15, evidence of intoxication, midline neck or back tenderness or pain, focal neurologic signs and/or symptoms, anatomic deformity of the spine, and distracting circumstances or injuries. This activity outlines and reviews the role of the interprofessional team in evaluating, treating, and managing patients who undergo spinal motion restriction. Objectives: Review the indications for utilizing spinal motion restriction. Summarize the potential complications of spinal motion restriction. Review the anatomy and pathophysiology of spinal column trauma and how it can lead to spinal cord injury, necessitating immobilization.. Outline some interprofessional team strategies to improve care coordination in cases where spinal immobilization is necessary, improving patient outcomes. Access free multiple choice questions on this topic.

Blunt traumatic injuries are the leading cause of spinal cord injuries in the United States, with an annual incidence of approximately 54 cases per million population and about 3% of all blunt trauma admissions to the hospital.[1] Although spinal cord injuries represent only a small percentage of blunt trauma injuries, they are among the largest contributors to morbidity and mortality.[2][3] As a result, in 1971, the American Academy of Orthopedic Surgeons proposed using a cervical collar and a long spine board for spinal motion restriction for patients with suspected spinal injuries, which was based entirely on the mechanism of injury. At the time, this was based on consensus rather than evidence.[4] In the decades since spinal motion restriction, using a cervical collar and long spine board has become the standard in prehospital care. It can be found in several guidelines, including the Advanced Trauma Life Support (ATLS) and Prehospital Trauma Life Support (PHTLS) guidelines. Despite their widespread use, the efficacy of these practices has been called into question. In one international study comparing those who underwent spinal motion restriction to those who did not, the study found that those who did not receive routine care with spinal motion restriction had fewer neurologic injuries with disability. However, it should be noted that these patients were not matched for the severity of the injury.[5] Using healthy young volunteers, another study looked at lateral spine motion on a long spine board compared to a stretcher mattress and found that the long spine board allowed the greater lateral motion.[6] In 2019, a retrospective, observational, multi-agency prehospital study examined whether or not there was a change in spinal cord injuries after implementing an EMS protocol that limited spinal precautions to only those with significant risk factors or abnormal exam findings and found that there was no difference in the incidence of spinal cord injuries.[7] There are currently no high-level randomized control trials to either support or refute the use of spinal motion restriction. It is unlikely there will be a patient to volunteer for a study that could result in permanent paralysis violates current ethical guidelines.

Using healthy young volunteers, another study looked at lateral spine motion on a long spine board compared to a stretcher mattress and found that the long spine board allowed the greater lateral motion.[6] In 2019, a retrospective, observational, multi-agency prehospital study examined whether or not there was a change in spinal cord injuries after implementing an EMS protocol that limited spinal precautions to only those with significant risk factors or abnormal exam findings and found that there was no difference in the incidence of spinal cord injuries.[7] There are currently no high-level randomized control trials to either support or refute the use of spinal motion restriction. It is unlikely there will be a patient to volunteer for a study that could result in permanent paralysis violates current ethical guidelines. As a result of these and other studies, newer guidelines recommend limiting the use of long spine board spinal motion restriction to those with a concerning mechanism of injury or concerning signs or symptoms as described later in this article and limiting the duration that a patient spends immobilized.

Pressure Injuries A potential complication in those undergoing prolonged long spine board and cervical spine motion restriction are pressure ulcers, with an incidence reported as high as 30.6%.[17] According to the National Pressure Ulcer Advisory Panel, pressure ulcers have now been reclassified as pressure injuries. They result from pressure, usually over bony prominences, for a prolonged time resulting in localized damage to the skin and soft tissue. In the early stages, the skin remains intact but may progress to an ulcer in later stages.[18] The amount of time it takes to develop a pressure injury varies, but at least one study demonstrated that tissue injury might begin in as little as 30 minutes in healthy volunteers.[19] Meanwhile, the average time spent immobilized on a long spine board is around 54 to 77 minutes, approximately 21 minutes of which is accrued in the ED after transport.[20][21] With this in mind, all providers must try to minimize the time patients spend immobilized either on rigid long spine boards or with cervical collars as both may lead to pressure injuries. Respiratory Compromise Multiple studies have demonstrated a reduction in respiratory function due to the straps used on long spine boards. In healthy young volunteers, the use of long spine board straps over the chest resulted in a decrease of several pulmonary parameters, including forced vital capacity, forced expiratory volume, and forced mid-expiratory flow resulting in a restrictive effect.[22] In a study involving children, there was a reduced forced vital capacity to 80% of baseline.[23] In yet another study, both rigid board and vacuum mattresses were found to restrict respiration by an average of 17% in healthy volunteers.[24] Careful attention must be paid when immobilization patients, particularly to those with a pre-existing pulmonary disease as well as children and the elderly Pain The most common, well-documented complication of long spine board spinal motion restriction is pain, resulting in as little as 30 minutes. Pain is most commonly manifested with headaches, back pain, and mandible pain.[25] Again, and by now a recurring theme, time spent on a rigid long spine board should be minimized to reduce pain.

Patients who have been involved in blunt force trauma may present with a myriad of symptoms. It is important for health care professionals responsible for the initial evaluation of these patients to be familiar with the indications, contraindications, potential complications, and proper technique of implementing spinal motion restriction. Several guidelines can exist to help determine which patients meet the criteria for spinal motion restriction. Perhaps the most well known and widely accepted guidelines is that of the joint position statement by the American College of Surgeons Committee on Trauma (ACS-COT), the National Association of EMS Physicians (NAEMSP), and the American College of Emergency Physicians (ACEP).[10] Although these are the current guidelines and recommendations, there are no high-quality randomized control trials to date, with recommendations being based on observational studies, retrospective cohorts, and case studies.[26] In addition to being familiar with the indications and contraindications for spinal motion restriction, it is also important for health care professionals to be familiar with the potential complications such as pain, pressure ulcers, and respiratory compromise. When implementing spinal motion restriction, all members of the interprofessional health care professionalsteam must be familiar with their preferred technique and exercise good communication to execute the technique properly and reduce excessive spinal motion. Health care professionals should also recognize that time spent on a long spine board should be minimized to reduce complications. When transferring care, the EMS team should communicate the total time spent on the long spine board. Utilizing the latest guidelines, being familiar with known complications, limiting time spent on the long spine board, and exercising excellent interprofessional communication outcomes for these patients can be optimized. [Level 3]