Kane Erin, Braithwaite Sabina
Washington University School of Medicine
Washington University in St Louis
Spinal immobilization with a backboard and cervical collar for patients with suspected spine injury became common practice in the 1960s. The increase in automobile accidents drove this decision as automobiles became more commonplace, and a position paper was published by the American Academy of Orthopedics endorsing its use without evidence that spinal immobilization improved outcomes. Spinal immobilization included a cervical collar and a rigid backboard with secured straps. Recent studies assessing the validity of spinal immobilization raised concern for harm instead of better outcomes). In the early 2010s, the common practice moved to spinal motion restriction to replace the common use of spinal immobilization. In 2019, a retrospective observational study from the University of Arizona showed no significant increase in spinal cord injury after transitioning from a spinal immobilization protocol to 1 of spinal motion restrictions. A joint position paper between the American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), and the National Association of Emergency Medicine Physicians (NAEMSP) in 2018 outlined the uniform recommendations for spinal motion restriction in the care of trauma patients. The indications for patients who have experienced blunt trauma are summarized in the table (see Indications for Spinal Motion Restriction). Patients with none of the identified indications should not undergo spinal motion restriction due to the potential for harm by being placed in a cervical collar or backboard. In the pediatric population, there is no indication based on age alone for using spinal motion restriction. Young patients can present a challenge to providers due to communication issues. A retrospective review completed by Hale et al of 2,972 pre-elementary trauma patients showed that CT scans were not necessary for patients less than 5 years old without clinical findings on the exam. In addition to the criteria listed in the table, torticollis indicates spinal motion restriction (particularly cervical collar placement) in pediatric patients.
20世纪60年代，对于疑似脊柱损伤的患者，使用背板和颈托进行脊柱固定成为了常见做法。随着汽车越来越普及，汽车事故的增加推动了这一决定，并且美国矫形外科学会发表了一篇立场文件，在没有证据表明脊柱固定能改善治疗效果的情况下支持其使用。脊柱固定包括一个颈托和一个带有固定带的刚性背板。最近评估脊柱固定有效性的研究引发了对其造成伤害而非带来更好治疗效果的担忧。在21世纪10年代初，常见做法转变为脊柱活动限制，以取代普遍使用的脊柱固定。2019年，亚利桑那大学的一项回顾性观察研究表明，从脊柱固定方案转变为一种脊柱活动限制方案后，脊髓损伤没有显著增加。美国外科医师学会创伤委员会（ACS - COT）、美国急诊医师学会（ACEP）和美国急诊医学医师协会（NAEMSP）在2018年联合发表的一篇立场文件概述了创伤患者护理中脊柱活动限制的统一建议。表中总结了钝性创伤患者的适应症（见脊柱活动限制的适应症）。没有任何已确定适应症的患者不应因佩戴颈托或背板可能造成伤害而接受脊柱活动限制。在儿科人群中，没有仅基于年龄就使用脊柱活动限制的适应症。由于沟通问题，年轻患者可能会给医护人员带来挑战。黑尔等人对2972名学前创伤患者进行的回顾性研究表明，对于5岁以下且检查无临床发现的患者，无需进行CT扫描。除了表中列出的标准外，斜颈表明儿科患者需要进行脊柱活动限制（特别是佩戴颈托）。
