A Comparison of Cervical Spine Motion After Immobilization With a Traditional Spine Board and Full-Body Vacuum-Mattress Splint

Abstract

Background:The National Athletic Trainers’ Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility.Purpose:To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulder pads, and (3) evaluate the effect of body mass on cervical spine motion.Study Design:Controlled laboratory study.Methods:Twenty healthy male participants volunteered for this study to examine the influence of immobilization type and presence of equipment on triplanar angular cervical spine motion. Three-dimensional cervical spine kinematics was measured using an electromagnetic motion analysis system. Independent variables included testing condition (static lift and hold, 30° tilt, transfer, equipment removal), immobilization type (rigid, vacuum-mattress), and equipment (on, off). Peak sagittal-, frontal-, and transverse-plane angular motions were the primary outcome measures of interest.Results:Subjective ratings of comfort and security did not differ between immobilization types (P > .05). Motion between the rigid board and vacuum splint did not differ by more than 2° under any testing condition, either with or without equipment. In removing equipment, the mean peak motion ranged from 12.5° to 14.0° for the rigid spine board and from 11.4° to 15.4° for the vacuum-mattress splint, and more transverse-plane motion occurred when using the vacuum-mattress splint compared with the rigid spine board (mean difference, 0.14 deg/s [95% CI, 0.05-0.23 deg/s]; P = .002). In patients weighing more than 250 lb, the rigid board provided less motion in the frontal plane (P = .027) and sagittal plane (P = .030) during the tilt condition and transfer condition, respectively.Conclusion:The current study confirms similar motion in the vacuum-mattress splint compared with the rigid backboard in varying sized equipped or nonequipped athletes. Cervical spine motion occurs when removing a football helmet and shoulder pads, at an unknown risk to the injured athlete. In athletes who weighed more than 250 lb, immobilization with the rigid board helped to reduce cervical spine motion.Clinical Relevance:Athletic trainers and team physicians should consider immobilization of athletes who weigh more than 250 lb with a rigid board.

Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury

“…Transfer with either fullbody vacuum immobilization or a rigid spine board for athletes in full equipment involved similar amounts of sagittal and frontal angular cervical spine motion, measured as angular motion normalized by time to peak motion (degrees/second). 25 Volunteer athletes did not report a significantly different level of perceived comfort or sense of security during transfer when immobilized with full-body vacuum immobilization or with a rigid spine board. 25 Question 5: What formal training in the emergency care of an athlete with an on-field suspected CSI is required and recommended?…”

“…25 Volunteer athletes did not report a significantly different level of perceived comfort or sense of security during transfer when immobilized with full-body vacuum immobilization or with a rigid spine board. 25 Question 5: What formal training in the emergency care of an athlete with an on-field suspected CSI is required and recommended? Through the systematic review, we determined that whereas pretest training on the techniques studied is included as part of most study protocols, there is very limited research (N ¼ 3) into the content or frequency of training itself.…”

“…Question 2b: Are outcomes after CSI likely to be better when the helmet/shoulder pads are removed prior to transport? The systematic review identified studies 22,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40] (N ¼ 18) of both static cervical alignment and dynamic cervical motion during immobilization in American tackle football, ice hockey, and lacrosse players. No studies directly examined patient outcomes.…”

“…26,30 Heavier athletes not wearing helmets or shoulder pads experienced less motion on a rigid spine board than when immobilized with vacuum devices. 25 Removing ice hockey helmets before the prone log-roll technique may reduce cervical spine motion. 30 Question 4: What method of transfer and spinal-motion restriction is associated with the best outcomes for athletes with suspected CSIs, in both the supine and prone position?…”

“…Conducting the systematic review (N ¼ 4), we found that some methods of transfer may involve less cervical spine motion. 25,[48][49][50] Using cadavers, the researchers of 1 study 48 showed that the log-roll push involved less lateral motion than the log-roll pull from the prone into the supine position. Authors of another cadaver study 49 reported that a lift-and-slide technique involved less cervical spine motion than the log roll when starting from a supine position, whereas an 8-person lift involved less motion than the liftand-slide or log-roll technique.…”