Patients Immobilized with a Long Spine Board Rarely Have Unstable Thoracolumbar Injuries

Most Emergency Medical Services (EMS) protocols require spine immobilization with both a cervical collar and long spine board for patients with suspected spine injuries. The goal of this research was to determine the prevalence of unstable thoracolumbar spine injuries among patients receiving prehospital spine immobilization: a 4-year retrospective review of adult subjects who received prehospital spine immobilization and were transported to a trauma center. Prehospital and hospital records were linked. Data was reviewed to determine if spine imaging was ordered, whether acute thoracolumbar fractures, dislocations, or subluxations were present. Thoracolumbar injuries were classified as unstable if operative repair was performed. Prehospital spine immobilization was documented on 5,593 unique adult subjects transported to the study hospital. A total of 5,423 (97.0%) prehospital records were successfully linked to hospital records. The subjects were 60.2% male, with a mean age of 40.6 (SD = 17.5) years old. An total of 5,286 (97.4%) subjects had sustained blunt trauma. Hospital providers ordered imaging to rule out spine injury in 2,782 (51.3%) cases. An acute thoracolumbar fracture, dislocation, or subluxation was present in 233 (4.3%) cases. An unstable injury was present in 29 (0.5%) cases. No unstable injuries were found among the 951 subjects who were immobilized following ground level falls. Hospital providers ordered at least one spine x-ray or CT in most patients, and a thoracolumbar imaging in half of all patients immobilized. Only 0.5% of patients who received prehospital spine immobilization had an unstable thoracolumbar spine injury.