A Change from a Spinal Immobilization to a Spinal Motion Restriction Protocol was Not Associated with an Increase in Disabling Spinal Cord Injuries

Abstract

Background:Over the past decade, Emergency Medical Service (EMS) systems decreased backboard use as they transition from spinal immobilization (SI) protocols to spinal motion restriction (SMR) protocols. Since this change, no study has examined its effect on the neurologic outcomes of patients with spine injuries.Objectives:The object of this study is to determine if a state-wide protocol change from an SI to an SMR protocol had an effect on the incidence of disabling spinal cord injuries.Methods:This was a retrospective review of patients in a single Level I trauma center before and after a change in spinal injury protocols. A two-step review of the record was used to classify spinal cord injuries as disabling or not disabling. A binary logistic regression was used to determine the effects of protocol, gender, age, level of injury, and mechanism of injury (MOI) on the incidence of significant disability from a spinal cord injury.Results:A total of 549 patients in the SI period and 623 patients in the SMR period were included in the analysis. In the logistic regression, the change from an SI protocol to an SMR protocol did not demonstrate a significant effect on the incidence of disabling spinal injuries (OR: 0.78; 95% CI, 0.44 - 1.36).Conclusion:This study did not demonstrate an increase in disabling spinal cord injuries after a shift from an SI protocol to an SMR protocol. This finding, in addition to existing literature, supports the introduction of SMR protocols and the decreased use of the backboard.

Wilderness Medical Society Clinical Practice Guidelines for Spinal Cord Protection: 2024 Update

“…61 In the United States, EMS systems that studied their own progression from immobilization protocols to SMR protocols did not see any increase in disabling spinal injuries in their patients with a transition to SMR protocols. 62 Recommendation: We suggest SCP should be considered an appropriate goal in patients with actual or suspected spinal injury; current evidence suggests SMR and not immobilization is the safest and most effective means of SCP. Weak recommendation, low-quality evidence.…”

“…In the United States, EMS systems that studied their own progression from immobilization protocols to SMR protocols did not see any increase in disabling spinal injuries in their patients with a transition to SMR protocols. 62…”

Patterns of change in prehospital spinal motion restriction: A retrospective database review

“…Additional research has examined patient characteristics and outcomes after introducing new guidelines, observing not only substantial undertreatment among patients who met criteria for precautions but also increases in the number of patients with confirmed injuries who received no treatment from emergency medical services (EMS) 20,21 . While a small number of additional studies using high‐level population data have observed no increase in a final diagnosis of spinal cord injury after SMR, 22,23 the prospects of variable practice, ineffective interventions, and patients not receiving the treatment intended for their injury remain a concern.…”

How paramedics apply the spinal immobilisation algorithm in trauma patients

“…The efficacy of semi-rigid collars has been questioned by Clemency et al (2021) and Hawkridge et al's (2020) systematic review found that most studies disagreed with spinal collars prehospital. Oosterwold et al (2017) identified potential issues with immobilisation as nausea/vomiting, pain, shortness of breath and combativeness/anxiety.…”