Until recently, the indication to provide spinal immobilization was solely based on:

  1. Davis JW, Hoyt DB, McArdle MS, Mackersie RC, Eastman AB, Virgilio RW, Cooper G, Hammill F, Lynch FP. An analysis of errors causing morbidity and mortality in a trauma system: a guide for quality improvement. J Trauma. 1992;32:660–5. discussion 665–666.

    CAS  Article  PubMed  Google Scholar 

  2. Wölfl CG, Bouillon B, Lackner CK, Wentzensen A, Gliwitzky B, Groß B, Brokmann J, Hauer T. Prehospital Trauma Life Support® (PHTLS®). Der Unfallchirurg. 2008;111:688–94.

    Article  PubMed  Google Scholar 

  3. Benger J, Blackham J. Why do we put cervical collars on conscious trauma patients? Scand J Trauma Resusc Emerg Med. 2009;17:44.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Toscano J. Prevention of neurological deterioration before admission to a spinal cord injury unit. Paraplegia. 1988;26:143–50.

    CAS  Article  PubMed  Google Scholar 

  5. Brunette DD, Rockswold GL. Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury. J Trauma. 1987;27:445–7.

    CAS  Article  PubMed  Google Scholar 

  6. Hauswald M, Ong G, Tandberg D, Omar Z. Out-of-hospital spinal immobilization: its effect on neurologic injury. Acad Emerg Med. 1998;5:214–9.

    CAS  Article  PubMed  Google Scholar 

  7. Abram S, Bulstrode C. Routine spinal immobilization in trauma patients: what are the advantages and disadvantages? Surgeon. 2010;8:218–22.

    CAS  Article  PubMed  Google Scholar 

  8. Sundstrom T, Asbjornsen H, Habiba S, Sunde GA, Wester K. Prehospital use of cervical collars in trauma patients: a critical review. J Neurotrauma. 2014;31:531–40.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hood N, Considine J. Spinal immobilisaton in pre-hospital and emergency care: A systematic review of the literature. Australas Emerg Nurs J. 2015;18:118–37.

    Article  PubMed  Google Scholar 

  10. Deasy C, Cameron P. Routine application of cervical collars--what is the evidence? Injury. 2011;42:841–2.

    Article  PubMed  Google Scholar 

  11. Askins V, Eismont FJ. Efficacy of five cervical orthoses in restricting cervical motion. A comparison study. Spine (Phila Pa 1976). 1997;22:1193–8.

    CAS  Article  Google Scholar 

  12. McCabe JB, Nolan DJ. Comparison of the effectiveness of different cervical immobilization collars. Ann Emerg Med. 1986;15:50–3.

    CAS  Article  PubMed  Google Scholar 

  13. James CY, Riemann BL, Munkasy BA, Joyner AB. Comparison of Cervical Spine Motion During Application Among 4 Rigid Immobilization Collars. J Athl Train. 2004;39:138–45.

    PubMed  PubMed Central  Google Scholar 

  14. Horodyski M, DiPaola CP, Conrad BP, Rechtine 2nd GR. Cervical collars are insufficient for immobilizing an unstable cervical spine injury. J Emerg Med. 2011;41:513–9.

    Article  PubMed  Google Scholar 

  15. Chandler DR, Nemejc C, Adkins RH, Waters RL. Emergency cervical-spine immobilization. Ann Emerg Med. 1992;21:1185–8.

    CAS  Article  PubMed  Google Scholar 

  16. Hostler D, Colburn D, Seitz SR. A comparison of three cervical immobilization devices. Prehosp Emerg Care. 2009;13:256–60.

    Article  PubMed  Google Scholar 

  17. Stone MB, Tubridy CM, Curran R. The effect of rigid cervical collars on internal jugular vein dimensions. Acad Emerg Med. 2010;17:100–2.

    Article  PubMed  Google Scholar 

  18. Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996;27:647–9.

    CAS  Article  PubMed  Google Scholar 

  19. Kolb JC, Summers RL, Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med. 1999;17:135–7.

    CAS  Article  PubMed  Google Scholar 

  20. Craig GR, Nielsen MS. Rigid cervical collars and intracranial pressure. Intensive Care Med. 1991;17:504–5.

    CAS  Article  PubMed  Google Scholar 

  21. Hunt K, Hallworth S, Smith M. The effects of rigid collar placement on intracranial and cerebral perfusion pressures. Anaesthesia. 2001;56:511–3.

    CAS  Article  PubMed  Google Scholar 

  22. Mobbs RJ, Stoodley MA, Fuller J. Effect of cervical hard collar on intracranial pressure after head injury. ANZ J Surg. 2002;72:389–91.

    Article  PubMed  Google Scholar 

  23. Bauer D, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med. 1988;17:915–8.

    CAS  Article  PubMed  Google Scholar 

  24. Goutcher CM, Lochhead V. Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth. 2005;95:344–8.

    CAS  Article  PubMed  Google Scholar 

  25. Holla M. Value of a rigid collar in addition to head blocks: a proof of principle study. Emerg Med J. 2012;29:104–7.

    CAS  Article  PubMed  Google Scholar 

  26. Cordell WH, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995;26:31–6.

    CAS  Article  PubMed  Google Scholar 

  27. Chan D, Goldberg R, Tascone A, Harmon S, Chan L. The effect of spinal immobilization on healthy volunteers. Ann Emerg Med. 1994;23:48–51.

    CAS  Article  PubMed  Google Scholar 

  28. Chan D, Goldberg RM, Mason J, Chan L. Backboard versus mattress splint immobilization: a comparison of symptoms generated. J Emerg Med. 1996;14:293–8.

    CAS  Article  PubMed  Google Scholar 

  29. Berg G, Nyberg S, Harrison P, Baumchen J, Gurss E, Hennes E. Near-infrared spectroscopy measurement of sacral tissue oxygen saturation in healthy volunteers immobilized on rigid spine boards. Prehosp Emerg Care. 2010;14:419–24.

    Article  PubMed  Google Scholar 

  30. Theodore N, Hadley MN, Aarabi B, Dhall SS, Gelb DE, Hurlbert RJ, Rozzelle CJ, Ryken TC, Walters BC. Prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;72 Suppl 2:22–34.

    Article  PubMed  Google Scholar 

  31. Deutsche Gesellschaft für Unfallchirurgie: S3 – Leitlinie Polytrauma/Schwerverletzten-Behandlung 2011, AWMF-Register Nr. 012/019. (http://www.awmf.org/leitlinien/detail/ll/012-019.html).

  32. White CC, Domeier RM, Millin MG. EMS spinal precautions and the use of the long backboard - resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. Prehosp Emerg Care. 2014;18:306–14.

    Article  PubMed  Google Scholar 

  33. Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60 Suppl 1:82–91.

    Article  PubMed  Google Scholar 

  34. Deutsche Gesellschaft für Unfallchirurgie (DGU); Sektion Intensiv- & Notfallmedizin SNA-AdUG: TraumaRegister DGU - Jahresbericht 2014. 2014. (http://www.dgu-online.de/qualitaet-sicherheit/schwerverletzte/traumaregister-dgur.html).

  35. Connor D, Greaves I, Porter K, Bloch M. Pre-hospital spinal immobilisation: an initial consensus statement. Emerg Med J. 2013;30:1067–9.

    CAS  Article  PubMed  Google Scholar 

  36. Haut ER, Kalish BT, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE, 3rd, Chang DC. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010;68:115–20. discussion 120–111.

    Article  PubMed  Google Scholar 

  37. Vaillancourt C, Stiell IG, Beaudoin T, Maloney J, Anton AR, Bradford P, Cain E, Travers A, Stempien M, Lees M, et al. The out-of-hospital validation of the Canadian C-Spine Rule by paramedics. Ann Emerg Med. 2009;54:663–671.e661.

    Article  PubMed  Google Scholar 

  38. Stiell IG, Wells GA, Vandemheen KL, Clement CM, Lesiuk H, De Maio VJ, Laupacis A, Schull M, McKnight RD, Verbeek R, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. Jama. 2001;286:1841–8.

    CAS  Article  PubMed  Google Scholar 

  39. Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343:94–9.

    CAS  Article  PubMed  Google Scholar 

  40. Goldberg W, Mueller C, Panacek E, Tigges S, Hoffman JR, Mower WR. Distribution and patterns of blunt traumatic cervical spine injury. Ann Emerg Med. 2001;38:17–21.

    CAS  Article  PubMed  Google Scholar 

  41. Burton JH, Dunn MG, Harmon NR, Hermanson TA, Bradshaw JR. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma. 2006;61:161–7.

    Article  PubMed  Google Scholar 

  42. Meldon SW, Brant TA, Cydulka RK, Collins TE, Shade BR. Out-of-hospital cervical spine clearance: agreement between emergency medical technicians and emergency physicians. J Trauma. 1998;45:1058–61.

    CAS  Article  PubMed  Google Scholar 

  43. Barkana Y, Stein M, Scope A, Maor R, Abramovich Y, Friedman Z, Knoller N. Prehospital stabilization of the cervical spine for penetrating injuries of the neck - is it necessary? Injury. 2000;31:305–9.

    CAS  Article  PubMed  Google Scholar 

  44. Armstrong BP, Simpson HK, Crouch R, Deakin CD. Prehospital clearance of the cervical spine: does it need to be a pain in the neck? Emerg Med J. 2007;24:501–3.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  45. Lin HL, Lee WC, Chen CW, Lin TY, Cheng YC, Yeh YS, Lin YK, Kuo LC. Neck collar used in treatment of victims of urban motorcycle accidents: over- or underprotection? Am J Emerg Med. 2011;29:1028–33.

    Article  PubMed  Google Scholar 

  46. Boissy P, Shrier I, Briere S, Mellete J, Fecteau L, Matheson GO, Garza D, Meeuwisse WH, Segal E, Boulay J, Steele RJ. Effectiveness of cervical spine stabilization techniques. Clin J Sport Med. 2011;21:80–8.

    Article  PubMed  Google Scholar 

  47. Connell RA, Graham CA, Munro PT. Is spinal immobilisation necessary for all patients sustaining isolated penetrating trauma? Injury. 2003;34:912–4.

    Article  PubMed  Google Scholar 

  48. Stuke LE, Pons PT, Guy JS, Chapleau WP, Butler FK, McSwain NE. Prehospital spine immobilization for penetrating trauma--review and recommendations from the Prehospital Trauma Life Support Executive Committee. J Trauma. 2011;71:763–9. discussion 769–770.

    Article  PubMed  Google Scholar 

  49. Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M, Fernie GR. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phila Pa 1976). 1999;24:1839–44.

    CAS  Article  Google Scholar 

  50. Hoffman JR, Wolfson AB, Todd K, Mower WR. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med. 1998;32:461–9.

    CAS  Article  PubMed  Google Scholar 

  51. Vaillancourt C, Charette M, Kasaboski A, Maloney J, Wells GA, Stiell IG. Evaluation of the safety of C-spine clearance by paramedics: design and methodology. BMC Emerg Med. 2011;11:1.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Vandemark RM. Radiology of the cervical spine in trauma patients: practice pitfalls and recommendations for improving efficiency and communication. AJR Am J Roentgenol. 1990;155:465–72.

    CAS  Article  PubMed  Google Scholar 

  53. Dunn TM, Dalton A, Dorfman T, Dunn WW. Are emergency medical technician-basics able to use a selective immobilization of the cervical spine protocol?: a preliminary report. Prehosp Emerg Care. 2004;8:207–11.

    PubMed  Google Scholar 

  54. Burton JH, Harmon NR, Dunn MG, Bradshaw JR. EMS provider findings and interventions with a statewide EMS spine-assessment protocol. Prehosp Emerg Care. 2005;9:303–9.

    Article  PubMed  Google Scholar 

  55. Domeier RM, Evans RW, Swor RA, Rivera-Rivera EJ, Frederiksen SM. Prehospital clinical findings associated with spinal injury. Prehosp Emerg Care. 1997;1:11–5.

    CAS  Article  PubMed  Google Scholar 

  56. Domeier RM, Frederiksen SM, Welch K. Prospective performance assessment of an out-of-hospital protocol for selective spine immobilization using clinical spine clearance criteria. Ann Emerg Med. 2005;46:123–31.

    Article  PubMed  Google Scholar 

  57. Domeier RM, Evans RW, Swor RA, Hancock JB, Fales W, Krohmer J, Frederiksen SM, Shork MA. The reliability of prehospital clinical evaluation for potential spinal injury is not affected by the mechanism of injury. Prehosp Emerg Care. 1999;3:332–7.

    CAS  Article  PubMed  Google Scholar 

  58. Hanson JA, Blackmore CC, Mann FA, Wilson AJ. Cervical spine injury: a clinical decision rule to identify high-risk patients for helical CT screening. AJR Am J Roentgenol. 2000;174:713–7.

    CAS  Article  PubMed  Google Scholar 

  59. Hasler RM, Exadaktylos AK, Bouamra O, Benneker LM, Clancy M, Sieber R, Zimmermann H, Lecky F. Epidemiology and predictors of spinal injury in adult major trauma patients: European cohort study. Eur Spine J. 2011;20:2174–80.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Bortsov AV, Platts-Mills TF, Peak DA, Jones JS, Swor RA, Domeier RM, Lee DC, Rathlev NK, Hendry PL, Fillingim RB, McLean SA. Pain distribution and predictors of widespread pain in the immediate aftermath of motor vehicle collision. Eur J Pain. 2013;17:1243–51.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  61. Agrawal A. Cervical spine clearance: a review and understanding of the concepts. JNMA J Nepal Med Assoc. 2008;47:244–50.

    CAS  PubMed  Google Scholar 

  62. Muhr MD, Seabrook DL, Wittwer LK. Paramedic use of a spinal injury clearance algorithm reduces spinal immobilization in the out-of-hospital setting. Prehosp Emerg Care. 1999;3:1–6.

    CAS  Article  PubMed  Google Scholar 

  63. Myers LA, Russi CS, Hankins DG, Berns KS, Zietlow SP. Efficacy and compliance of a prehospital spinal immobilization guideline. Int J Emerg Med. 2009;2:13–7.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Anderson PA, Muchow RD, Munoz A, Tontz WL, Resnick DK. Clearance of the asymptomatic cervical spine: a meta-analysis. J Orthop Trauma. 2010;24:100–6.

    Article  PubMed  Google Scholar 


Page 2

  • Policies
  • Accessibility
  • Press center
  • Support and Contact
  • Leave feedback
  • Careers

Follow BMC

  • BMC Twitter page
  • BMC Facebook page
  • BMC Weibo page