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Pediatric cervical-spine immobilization: achieving neutral position?
C Curran1, A M Dietrich, M J Bowman
1Ohio State University College of Medicine, Columbus, USA.
Insights
Current immobilization methods fail to achieve neutral cervical spine positioning in pediatric trauma patients. Most pediatric trauma patients requiring immobilization exhibit significant spinal angulation, indicating a need for improved techniques.
Area of Science:
- Orthopedics
- Pediatric Trauma Care
- Radiology
Background:
- Cervical spine immobilization is crucial in pediatric trauma.
- Maintaining a neutral cervical spine position is essential for preventing secondary injury.
- Current devices' efficacy in pediatric patients is not well-established.
Purpose of the Study:
- To prospectively assess the effectiveness of current spine immobilization devices.
- To evaluate the achievement of radiographic-neutral cervical spine positioning in pediatric trauma patients.
- To compare different immobilization methods and their impact on cervical spine alignment.
Main Methods:
- Prospective evaluation of pediatric trauma patients requiring cervical spine immobilization.
- Lateral cervical spine radiography obtained during immobilization.
- Measurement of cervical spine Cobb angle (C2-C6) using a goniometer.
- Comparison of immobilization methods, patient age, and Cobb angle.
Main Results:
- 118 pediatric trauma patients (average age 7.9 years) were enrolled.
- Only 12% of patients achieved a neutral cervical spine position (0 degrees).
- 60% of patients showed >5 degrees of kyphosis or lordosis; 37% had >10 degrees.
- Common immobilization methods (collar, backboard, towels/blocks) were ineffective in achieving neutral alignment.
Conclusions:
- Current spine immobilization devices are inadequate for achieving neutral cervical spine positioning in pediatric trauma patients.
- Significant cervical spine angulation is common despite immobilization efforts.
- Further research is needed to develop and validate effective immobilization strategies for pediatric trauma.
Abstract:
This study was designed to evaluate prospectively the ability of current spine-immobilization devices to achieve radiographic-neutral positioning of the cervical spine in pediatric trauma patients. All trauma patients who required spinal immobilization and a lateral cervical spine radiograph were included in the study. A lateral cervical spine radiograph was obtained while the child was immobilized. The Cobb angle (C2-C6) was measured using a handheld goniometer. The method of immobilization, age at injury, and Cobb angle were compared. One hundred and eighteen patients with an average age of 7.9 years were enrolled. The majority were males (71%). The most frequent mechanisms of injury included motor vehicle accidents (35%) and falls (32%). The average Glascow Coma Scale score was 14. Although 31% of the children complained of neck pain, 92% were without neurologic deficits. The Cobb angles ranged from 27 degree kyphosis to 27 degree lordosis, and only 12 of the patients presented in a neutral position (0 degrees). Greater than 5 degrees of kyphosis or lordosis was observed in 60% of the children. Thirty-seven percent of the patients had 10 degrees or greater angulation. The most frequent methods of immobilization included a collar, backboard, and towels (40%), and a collar, backboard, and blocks (20%), but these techniques provided < 5 degrees kyphosis or lordosis in only 45% and 26% of the children respectively. No single method or combination of methods of immobilization consistently placed the children in the neutral position.(ABSTRACT TRUNCATED AT 250 WORDS)