Stabilization of spinal injury for early transfer

We have reviewed the means of transport and type of stabilization used for all patients with acute spinal cord injuries (SCI) transferred to our center since 1985 to determine what effect these variables may have had on change in level of impairment and probability of neurologic improvement after arrival. Sixty-one patients were reviewed, 47 males and 14 females, with a mean age of 34 years. Twenty-five patients (41%) were transported by ground ambulance, 33 (54%) by helicopter, three (5%) by fixed-wing aircraft. Forty-three patients (70.5%) had cervical spine injuries, 11 (18%), thoracic spine injuries, and seven (11.5%), lumbar spine injuries. Fifty-one patients (84%) were transferred within 24 hours of injury. A variety of standard methods of stabilization were used during transport. No patient suffered ascending level of injury as a result of early transfer. Level of function improved before discharge in 26 of 61 patients (43%); patients transported within 24 hours were more likely to show improvement (25/51) than those transported after 24 hours (1/10). There was no significant difference in the probability of improvement between ground (8/25) or air (18/36) transport. Skeletal traction was used before transfer in only four of 43 patients with cervical spine injuries, and was maintained as a method of long-term stabilization in two patients. We conclude that acute SCI patients can be safely transported by air or ground using standard precautions. Distance and extent of associated injury are the best determinants of mode of transport. Skeletal traction does not appear to be a prerequisite for safe, early transfer of SCI patients.