C-Spine versus lower spine immobilization

[AnthonyM83]

So last time we had a big discussion on spinal immobilization a few months ago, a number of people mentioned that trauma to lower back was unlikely to cause cervical spine injury . . . I asked a follow-up question a couple times without reply.

If you have a localized injury to the thoracic or lumbar spine, do you still immobilize the cervical? Is it all or nothing? If it's all, then I guess we're not really overusing c-spine for lower back injuries, b/c the cspine immobilization is just part of the lower back immobilization.

Do those questions make sense?

[Kaisu]

you ask super good questions ... I was taught that it is all or nothing... any tenderness, pain, etc. along the spine gets the collar and the long board... the idea is immobilization along the entire spine.

Case in point.. the motorcycle guy that gets the head into a car injury - classic injury pattern is compression fracture of the anterior vertebral body somewhere around T2-3-4. (head hits, spine flexes). I don't think anyone would argue that this guy gets the whole monte...

my thought is that if the mechanism of injury warrents a high degree of suspician, any ETOH is on board, and/or palpitation progressing to cautious movement elicits any pain, tenderness, tingling, etc. they get it all, regardless of where the suspected injury is.

[AnthonyM83]

my thought is that if the mechanism of injury warrents a high degree of suspician, any ETOH is on board, and/or palpitation progressing to cautious movement elicits any pain, tenderness, tingling, etc. they get it all, regardless of where the suspected injury is.

And regardless of mechanism of injury, right (as long as it's gives you high suspicion)? Just want to confirm...b/c the example is one where it's hard to know if injury is localized. Let's say guy gets punched in the back...or ..hmm I can't think of any right now, but I've come across them. I think tire iron to lower back might be to strong? No? In those cases cervical, too, collar, head tape, etc.

[spenac]

Great question. Where I work it's all or nothing. Do not know if that is based on any facts though. A question I have is for someone that had a witnessed trauma to lower back would leaving there neck free to move cause additional injury to the lower spine? Say patient is sitting eating lunch on construction site. Board gets loose in the wind and hits patient on back. Patient does not fall but is lowered gently to ground by workmates. Nothing to indicate c-spine injury. In fact lets say you have a call God card and he confirms no c-spine injury. So would leaving c-collar off potentially lead to more injury of lower spine? Any research to support your statements?

[Kaisu]

Let's say guy gets punched in the back

I don't want to rehash the arguments that I'm sure raged on this board (although I'm too lazy to look 'em up and read 'em). I've seen 70 year olds with arthritis and kiophosis strapped onto a board. In this case, what's hurting the patient more? The injury or the treatment?

Like everything else in medicine, you kinda gotta be there.... it's always a weighting of factors and a judgement call. In this litigation happy society, its always better to err on the side of caution.

[Kaisu]

So would leaving c-collar off potentially lead to more injury of lower spine? Any research to support your statements?

Great question. Who does the research in EMS anyway? Is it all corporations trying to sell us something? Does the NREMT or a like organization funnel fees into non-biased, fact based research? May be Rid or Dust would know. If not, organization and/or advancement in this area might go a long way to improving our profession.

[firedoc5]

It does depend on modality of injury. But you have to remember, it's all connected. Someone gets hit across the lower back by an object, was it hard enough to whip back the thoracic and c-spine? Had a guy hit by a ball bat mid lumbar. It made him buckle back wards and the next week I saw him he had a c-collar on for a whiplash type of injury.

It was usually all or nothing, but at times we did board someone, but we did not use a c-collar, but we did immobalize the head with sandbags or blocks just to limit movement.

[ccmedoc]

I go with...it depends. It depends a lot on MOI. If there is the least possibility that the lower pain may be a distracting injury to a less painful c-spine injury..I agree with all CID and immobilization. Getting punched in the back...thats a little bit of a stretch..

It is not as much inline spinal immobilization that creates or exacerbates injuries..it is improper spinal immobilization, IMHO. Here is something to look at. Most journal articles on the subject require a subscription to see more than the abstract..

http://books.google.com/books?id=x2rL_2s5o...V9o_M&hl=en

[AZCEP]

Consider the spinal column to be similar to any other long bone with a joint at both ends. If you immobilize the center of the bone, but don't secure the two ends movement at either one will reduce the effectiveness in the center. The movement may not be much, but it doesn't take much to misalign the column.

[Freaknuggetz_chick]

hmmm.... all depends on the type of injury. i am more likely to go all out though, just to be certain. however there are times when an isolated neck injury has occured, and i've just used a collar and KED. another time i encountered a pt that i really really wanted to fully immobilize on a spine board, but due to extreme pain he couldnt lay down. so we had to use the KED (with collar).....ended up he had something like 6 ribs in his back broken.