Cadaveric study of movement in the unstable upper cervical spine during emergency management: tracheal intubation and cervical spine immobilisation—a study protocol for a prospective randomised crossover trial

Abstract

IntroductionEmergency management of upper cervical spine injuries often requires cervical spine immobilisation and some critical patients also require airway management. The movement of cervical spine created by tracheal intubation and cervical spine immobilisation can potentially exacerbate cervical spinal cord injury. However, the evidence that previous studies have provided remains unclear, due to lack of a direct measurement technique for dural sac's space during dynamic processes. Our study will use myelography method and a wireless human motion tracker to characterise and compare the change of dural sac's space during tracheal intubations and cervical spine immobilisation in the presence of unstable upper cervical spine injury such as atlanto-occipital dislocation or type II odontoid fracture.Methods and analysisPerform laryngoscopy and intubation, video laryngoscope intubation, laryngeal tube insertion, fiberoptic intubation and cervical collar application on cadaveric models of unstable upper cervical spine injury such as atlanto-occipital dislocation or type II odontoid fracture. The change of dural sac's space and the motion of unstable cervical segment are recorded by video fluoroscopy with previously performing myelography, which enables us to directly measure dural sac's space. Simultaneously, the whole cervical spine motion is recorded at a wireless human motion tracker. The maximum dural sac compression and the maximum angulation and distraction of the injured segment are measured by reviewing fluoroscopic and myelography images.Ethics and disseminationThis study protocol has been approved by the Ethics Committee of the State Medical Association Rhineland-Palatinate, Mainz, Germany. The results will be published in relevant emergency journals and presented at relevant conferences.Trial registration numberDRKS00010499.

Analysis of remaining motion using one innovative upper airway opening cervical collar and two traditional cervical collars

“…Previous studies have shown that after an initial trauma, no further injury or aggravation can occur through further manipulation 39 . However, recent biomechanical studies have shown a direct correlation between manipulation of the severely injured cervical spine and the width of the dural sac 29 , 30 , 40 . Furthermore, the application of a cervical collar itself may aggravate a spinal injury 29 .…”

Cervical Spine Immobilization in Patients With a Geriatric Facial Structure: The Influence of a Geriatric Mandible Structure on the Immobilization Quality Using a Cervical Collar

“…While previous studies have shown that after an initial trauma, no further aggravation can occur through further manipulation, 34 recent biomechanical studies have shown a direct correlation between manipulations and the width of the dural sac in the injured upper cervical spine. 25,26,35 The present study is limited by the very small group of fresh human cadavers. In a continuing study on living subjects, the accuracy of fit of the cervical collars could be verified.…”

Atemwegsmanagement bei Verletzungen der Halswirbelsäule

“…Beide Verfahren weisen bei fragwürdigen Vorteilen mit einer meist nur insuffizienten Immobilisation und gleichzeitig relevanten Nachteilen (Kompression, Erhöhung des Hirndrucks, Einschränkung der Respiration und erschwerte Intubationsbedingungen mit geringerem Erfolg) ein ungünstiges Nutzen-Risiko-Verhältnis auf, sodass deren Verwendung insbesondere bei begleitendem SHT zunehmend kontrovers diskutiert wird. Zudem kann bereits das Anlegen einer Zervikalstütze messbare Bewegungen der HWS verursachen [26].…”