Spinal Motion Restriction

For decades, spinal immobilization (SI) has been the standard practice when moving trauma patients with potential spinal injuries. Indeed, this particular procedure has long been commonplace for patients injured in the backcountry. Spinal immobilization involves the use of various devices, including a long spine board (LSB) and a cervical collar to stabilize the spine and prevent further injury.  

However, recent research has called this practice into question. In fact, while current techniques limit or reduce undesired motion of the spine, they do not succeed in fully immobilizing the spine. For this reason, the term “spinal motion restriction (SMR)” has gained favor over “spinal immobilization.” 

Both terms refer to the same concept — minimizing unwanted movement of the potentially injured spine. However, while LSBs have historically been used to attempt spinal immobilization, SMR may be achieved using a scoop stretcher, vacuum splint, ambulance cot, or other similar device to which a patient is safely secured.

The National Registry of Emergency Medical Technicians (NREMT) defines the term “spinal immobilization” as the use of adjuncts (LSB, cervical collar, etc.) to prevent movement of the spine. The term “spinal motion restriction” is defined more broadly as attempting to maintain the spine in anatomic alignment and minimizing gross movement — irrespective of adjuncts.

Evaluating the Efficacy of Spinal Immobilization

The effectiveness of the LSB to prevent further trauma to the spine has never been proven in high-level trials. Its use was adopted largely by consensus and not driven by data from any formal studies. An extensive literature review on the history of not using the LSB as a tool concluded that it is ineffective and may be detrimental by delaying time-sensitive treatments for some patients.

A study published by Cambridge University Press examined patient outcomes over a decade during which Emergency Medical Service (EMS) systems decreased backboard use as they transitioned from SI to SMR protocols. The study included (more…)