Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction—A study in two new cadaveric trauma models

Liao, Shunbao; Schneider, Nico; Hüttlin, Petra; Grützner, Paul Alfred; Weilbacher, Frank; Matschke, Stefan; Popp, Erik; Kreinest, Michael

doi:10.1371/journal.pone.0195215

Cited by 26 publications

(26 citation statements)

References 66 publications

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“…A possible explanation is the fact that, over the years, no evidence for the benefit of immobilization for patient outcomes has been obtained from rigorous studies (e.g., randomized controlled trials) [5][6][7]. Furthermore, regardless of the method, immobilization has its disadvantages, such as general patient manipulation, pain, decubitus, and prolonged pre-hospital time [8,9].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

Häske

Lefering

Stock

et al. 2020

Eur J Trauma Emerg Surg

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Purpose This study aimed to identify the prevalence and predictors of spinal injuries that are suitable for immobilization. Methods Retrospective cohort study drawing from the multi-center database of the TraumaRegister DGU®, spinal injury patients ≥ 16 years of age who scored ≥ 3 on the Abbreviated Injury Scale (AIS) between 2009 and 2016 were enrolled. Results The mean age of the 145,833 patients enrolled was 52.7 ± 21.1 years. The hospital mortality rate was 13.9%, and the mean injury severity score (ISS) was 21.8 ± 11.8. Seventy percent of patients had no spine injury, 25.9% scored 2–3 on the AIS, and 4.1% scored 4–6 on the AIS. Among patients with isolated traumatic brain injury (TBI), 26.8% had spinal injuries with an AIS score of 4–6. Among patients with multi-system trauma and TBI, 44.7% had spinal injuries that scored 4–6 on the AIS. Regression analysis predicted a serious spine injury (SI; AIS 3–6) with a prevalence of 10.6% and cervical spine injury (CSI; AIS 3–6) with a prevalence of 5.1%. Blunt trauma was a predictor for SI and CSI (OR 4.066 and OR 3.640, respectively; both p < 0.001) and fall > 3 m for SI (OR 2.243; p < 0.001) but not CSI (OR 0.636; p < 0.001). Pre-hospital shock was predictive for SI and CSI (OR 1.87 and OR 2.342, respectively; both p < 0.001), and diminished or absent motor response was also predictive for SI (OR 3.171) and CSI (OR 7.462; both p < 0.001). Patients over 65 years of age were more frequently affected by CSI. Conclusions In addition to the clinical symptoms of pain, we identify ‘4S’ [spill (fall) > 3 m, seniority (age > 65 years), seriously injured, skull/traumatic brain injury] as an indication for increased attention for CSIs or indication for spinal motion restriction.

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Section: Introductionmentioning

confidence: 99%

Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

Häske

Lefering

Stock

et al. 2020

Eur J Trauma Emerg Surg

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“…Years of precise instruction based on assumptions have been appropriately challenged by scientific examination. [22][23][24][25] Regardless, this concept has been reinforced at all levels of prehospital and hospital provider education that has led to expected spinal immobilization practice competencies. 26 Unfortunately, the medico-legal application of standard of care has only further promulgated the doctrine, despite widely accepted studies demonstrating the contrary in most clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

Weinstein

Cuthbertson

Ragazzoni

et al. 2020

Prehosp. Disaster med.

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Abstract Introduction: Emerging evidence is guiding changes in prehospital management of potential spinal injuries. The majority of settings related to current recommendations are in resource-rich environments (RREs), whereas there is a lack of guidance on the provision of spinal motion restriction (SMR) in resource-scarce environments (RSEs), such as: mass-casualty incidents (MCIs); low-middle income countries; complex humanitarian emergencies; conflict zones; and prolonged transport times. The application of Translational Science (TS) in the Disaster Medicine (DM) context was used to develop this study, leading to statements that can be used in the creation of evidence-based clinical guidelines (CGs). Objective: What is appropriate SMR in RSEs? Methods: The first round of this modified Delphi (mD) study was a structured focus group conducted at the World Association for Disaster and Emergency Medicine (WADEM) Congress in Brisbane Australia on May 9, 2019. The result of the focus group discussion of open-ended questions produced ten statements that were added to ten statements derived from Fischer (2018) to create the second mD round questionnaire. Academic researchers and educators, operational first responders, or first receivers of patients with suspected spinal injuries were identified to be mD experts. Experts rated their agreement with each statement on a seven-point linear numeric scale. Consensus amongst experts was defined as a standard deviation ≤1.0. Statements that were in agreement reaching consensus were included in the final report; those that were not in agreement but reached consensus were removed from further consideration. Those not reaching consensus advanced to the third mD round. For subsequent rounds, experts were shown the mean response and their own response for each of the remaining statements and asked to reconsider their rating. As above, those that did not reach consensus advanced to the next round until consensus was reached for each statement. Results: Twenty-two experts agreed to participate with 19 completing the second mD round and 16 completing the third mD round. Eleven statements reached consensus. Nine statements did not reach consensus. Conclusions: Experts reached consensus offering 11 statements to be incorporated into the creation of SMR CGs in RSEs. The nine statements that did not reach consensus can be further studied and potentially modified to determine if these can be considered in SMR CGs in RSEs.

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“…Immobilization by a cervical collar to protect the patient from secondary damage is a standard procedure in cervical spine trauma patients [12,13]. However, more studies have pointed out that applying a cervical collar in general will cause immense three-dimensional movement, and extrication collars can result in abnormal movement within the upper cervical spine in the presence of a severe injury [14][15][16]. We believe that an absolute restriction of the cervical spine cannot be only achieved by the cervical collar during preoperative positioning and may cause secondary dislocation in those with spinal cord injury, especially in the presence of a dissociative injury [17].…”

Section: Discussionmentioning

confidence: 99%

A Modified Prone Position Using A Body-Shape Plaster Bed and Skull Traction for Posterior Cervical Spine Surgeries

Ding

Wang

et al. 2020

Preprint

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Background A modified prone cervical spine surgical position using a body-shape plaster bed with skull traction (BSPST) was compared with the traditional prone surgical position with horseshoe headrests. Methods Forty-seven patients undergoing posterior cervical spine surgery for cervical spine fracture were retrospectively classified into two groups, BSPST group (n = 24) and traditional group (n = 23) and underwent posterior instrumented fusion with or without decompression. Multiple indicators were used to evaluate the advantages of the BSPST compared with the traditional position. Results All the operations went smoothly. The mean recovery rate was 56.30% in the BSPST group and 48.55% in the traditional group, with no significant difference. Intraoperative blood loss and total incidence of complications were significantly less in the BSPST group than in the traditional group. In addition, the BSPST position provided greater comfort level for the operators and allowed convenient intraoperative radiography. Conclusions This is the first study to describe a combined body-shape plaster bed and skull traction as a modified cervical spine prone surgical position that is simple, safe and stable, adjustable during surgery, reproducible and economical for posterior cervical spine fracture surgery and potentially other cervical and upper dorsal spine surgeries in the prone position. Additionally, this position provides surgeons a comfortable surgical field and can be easily achieved in most orthopedic operation rooms.

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Motion and dural sac compression in the upper cervical spine during the application of a cervical collar in case of unstable craniocervical junction—A study in two new cadaveric trauma models

Cited by 26 publications

References 66 publications

Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

Epidemiology and predictors of traumatic spine injury in severely injured patients: implications for emergency procedures

A T2 Translational Science Modified Delphi Study: Spinal Motion Restriction in a Resource-Scarce Environment

A Modified Prone Position Using A Body-Shape Plaster Bed and Skull Traction for Posterior Cervical Spine Surgeries

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