Spinal Motion Restriction for Possible Traumatic Cervical Spine Injury: A Scoping Review

Spinal motion restriction protocols are used worldwide by Emergency Medical Service professionals for patients with suspected spinal injuries. Similar guidance for trained and untrained first aid providers is currently lacking and continuously debated, fueled by ongoing controversy on the use of cervical collars by lay first aid providers and evidence of potential harm of spinal motion restriction practices and devices. A systematic collection of the available evidence may provide much-needed clarity and inform policy. The aim of this review was to scope the literature published since 1999 on the effectiveness of prehospital cervical spinal motion restriction, as part of the continuous evidence evaluation process of the International Liaison Committee on Resuscitation. In this scoping review, spinal motion restriction is defined as attempting to maintain the spine in anatomic alignment and minimizing gross movement with or without adjuncts or devices. We searched MEDLINE, Embase, and CINAHL Plus from inception until July 30, 2024, for studies comparing spinal motion restriction with no spinal motion restriction or with other types of spinal motion restriction. Extracted data were synthesized narratively using frequency counting and visualized in interactive evidence gap maps. Sixty-six studies were included. The vast majority (76%) of the 47 experimental studies were performed on live human volunteers to assess a range of cervical motion and adverse effects. The 19 observational studies mainly investigated the risk of secondary spinal injury, functional outcomes, and adverse effects in trauma patients. In none of the included studies, spinal motion restriction interventions were applied by first aid providers (whether trained or untrained). Only seven studies were conducted in low- and middle-income countries. Just two studies investigated improvised devices, which may be useful for first aid providers in low-resource settings. This scoping review provides a comprehensive and graphic overview of the available evidence on prehospital cervical spinal motion restriction. In doing so, it exposed multiple research gaps, including the lack of studies in which these interventions are applied by first aid providers, the paucity of research performed in low- and middle-income countries, and a further need for research involving adults and children with possible traumatic cervical spine injuries, as well as studies using improvised devices. This scoping review may serve as a basis for future systematic reviews that are required to confidently formulate evidence-based first aid treatment recommendations. It could also contribute to minimizing research waste and help prioritizing primary research on this topic.