Remember the heartwarming children’s tale of the young woman with the ribbon around her neck? Once removed, the head falls from the body, and the unfortunate woman expires. Thus, the inspiration and evidential basis for modern trauma care utilizing immobilization of the cervical spine.
This article asks a very simple question: is there evidence to support the notion of incidental cerebrospinal movement resulting in subsequent paralysis? Their answer: probably not.
These authors review several thousand abstracts to extract twelve publications describing a mere 41 cases of patients who were not completely immobilized, and thence suffered subsequent neurologic deterioration. The individual cases reported upon provide, generally, rather spotty detail regarding the circumstances. Some patients had additional falls or trauma in the ED, others were intoxicated and combative, while many others seemed to have gradual worsening without a specific event.
These authors propose this gradual worsening represents the primary time scale of neurologic deterioration – and suggest the suspected precipitating events documented by these cases represent contextual red herrings. Rather than becoming tetraplegic as a consequence of repositioning in the Emergency Department, it is more likely clinical manifestations result from ligamentous disruption, bleeding, and edema related to the primary injury, and immobilization would not have prevented their progression.
Of course, this paucity of documented examples cannot represent an exhaustive report of all known secondary deterioration after an initial, non-immobilized injury. However, just as erroneous is the presumption that immobilization prevents such secondary deterioration – particularly when coupled with the known inconveniences and harms of mass immobilization during transport and evaluation.
It’s time for routine cervical spine immobilization to go! However, such discontinuation need be undertaken in such a setting as capable of detecting any adverse events resulting from such.
“Early Secondary Neurologic Deterioration After Blunt Spinal Trauma: A Review of the Literature”
http://www.ncbi.nlm.nih.gov/pubmed/26394232