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Literature Review: Stabilizing Cervical Spine During a Traumatic Injury

Mary Hawara

California State University, Channel Islands

HLTH-499: Senior Capstone Project

Dr. Ashley Winans

10/01/2021
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Literature Review: Stabilizing Cervical Spine During a Traumatic Injury

Cervical spinal cord injuries are typically considered one of the most severe types of

spinal cord injuries. These injuries may result in quadriplegia or tetraplegia with associated loss

of muscle strength in all four extremities, depending on the location of the injury. Over the years,

treatments of spinal traumatic injuries have been altered in order to monitor the number of

outcomes or long-term damage (Yorkgitis & McCauley, 2019). In this literature review, I will be

covering the basics of treatments and any changes conducted for the long run compared to the

number of survival rates and mortality.

Cervical Stabilization Background

Immobilization of the cervical spine has long been considered the standard of care in the

management of trauma patients with suspected spinal cord injury. Research has shown both

physical and neurological consequences for the delay of stabilization (Atesok et al., 2019).

Ateskok et al. have also emphasized that the lack of immobilizing the cervical spine may lead to

whiplash injury that has been typically diagnosed after a spine injury. Back when doctors

considered this “typical” phenomenon until later it was discovered that this injury could have

been avoided.

When the extension of the spinal cord injury is unknown, it is advised that spinal

immobilization is important and must be fulfilled until a full assessment is conducted and any

complications are ruled out (Desai et al., 2018). This immobilization protects the patients during

intubation and any other aggressive and invasive treatments whilst the spinal assessment is being

conducted. According to the article written by Phaily & Khan, 2018, previous research regarding

immobilization of the c-spine might have been “exaggerated” in which the article argues that it is

quite impossible to pinpoint any complications due to the lack of stabilizing the cord (Phaily &
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Khan, 2018). The article stated the following, “ it is worth noting that an estimated 5% of

patients with spinal cord injuries develop a deterioration in neurological function despite

appropriate immobilization” (Phaily & Khan, 2018). The article aims to discuss that

immobilization may not be necessary and there should be many other priorities rather than

stabilization.

Another article that contraindicated the use of immobilization when it comes to spinal

cord injuries had discussed that this action may cause more harm than safety measures. Hawkins

et al., (2019) mentioned that cervical spine immobilization has been associated with a higher

incidence of morbidity, and even mortality when used in cases of penetrating cervical trauma

(Hawkins et al., 2019). The article argued that stabilization of the spinal cord may mask

symptoms of tracheal deviation, expanding hematoma, and diminished or absent carotid pulse,

and could even get in the way of endotracheal intubation. Thus the usage of the cervical collar

may not be necessary in all cases.

On the other hand, the article was written by Hager et al., (2020) highlights the

importance of maintaining spinal cord stabilization within 72 hours of injury. The article

mentions that early interventions such as using cervical collars provide enough stabilizations for

unstable patients whilst they were waiting for surgical treatments. Early stabilization of clients

has shown to provide pain relief as well as increase the ability to adequately position the patient,

and decrease the risk of complications like ARDS, wound infection, urinary tract infection, and

the development of pressure sores (Hager et al., 2020). Hager et al., also discussed that the delay

of stabilization had led to severe head, abdominal, and extremity trauma in patients.

The benefits of stabilizing the spin have also been discussed in “Early spinal injury

stabilization in multiple-injured patients: Do all patients benefit?” (Kobbe et al., 2020). It is

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stated that increasing time to spinal stabilization in multiple-injured patients is an independent

risk factor for an increased ICU and hospital stay as well as the development of sepsis. The

article mentioned that Immediate stabilization promotes better surgical outcomes as well as a

decrease in the duration of mechanical ventilation and improvement of out-of-mobility (Kobbe et

al., 2020). Patients are more likely to die if surgical interventions are being conducted during

their unstable stage, however, the article promoted that early stabilization allows a grace period

and helps stabilize patients, thus decreasing the delay in surgical treatments.

Conclusion

Early stabilization of the cervical spinal cord is considered a dilemma noting that we do

not have enough evidence regarding whether it is actually beneficial or not. There are many

aspects that could alter a patient’s condition post-traumatic injury including masked deviated

trachea, embolism, fractures...etc. Further research is being conducted to evaluate the

effectiveness of cervical collars and whether it benefits the patients or provides more damage.
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References

Atesok, K., Tanaka, N., Robinson, Y., Pittman, J., & Theiss, S. (2019). Current best practices

and

emerging approaches in the management of acute spinal trauma. Advances in

Orthopedics, 2019, 1-2. https://doi.org/10.1155/2019/8634260

Desai, S., Liu, C., Kirkland, S. W., Krebs, L. D., Keto‐Lambert, D., & Rowe, B. H. (2018).

Effectiveness of implementing evidence‐based interventions to reduce C‐spine image

ordering in the emergency department: A systematic review. Academic Emergency

Medicine, 25(6), 672-683. https://doi.org/10.1111/acem.13364

Hager, S., Eberbach, H., Lefering, R., Hammer, T. O., Kubosch, D., Jäger, C., Südkamp, N. P.,

&

Bayer, J. (2020). Possible advantages of early stabilization of spinal fractures in multiply

injured patients with leading thoracic trauma - analysis based on the TraumaRegister

DGU®. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 28(1).

https://doi.org/10.1186/s13049-020-00737-6

Hawkins, S. C., Williams, J., Bennett, B. L., Islas, A., Kayser, D. W., & Quinn, R. (2019).

Wilderness Medical Society clinical practice guidelines for spinal cord protection.

Wilderness & Environmental Medicine, 30(4), S87-S99.

https://doi.org/10.1016/j.wem.2019.08.001

Kobbe, P., Krug, P., Andruszkow, H., Pishnamaz, M., Hofman, M., Horst, K., Meyer, C.,

Scheyerer, M. J., Faymonville, C., Stein, G., Hildebrand, F., & Herren, C. (2020). Early

spinal injury stabilization in multiple-injured patients: Do all patients benefit? Journal of

Clinical Medicine, 9(6), 1760. https://doi.org/10.3390/jcm9061760

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Phaily, A., & Khan, M. (2018). Is our current method of cervical spine control doing more harm

than good? Trauma, 21(3), 176-183. https://doi.org/10.1177/1460408618777773

Yorkgitis, B. K., & McCauley, D. M. (2019). Cervical spine clearance in adult trauma patients.

Journal of the American Academy of Physician Assistants, 32(2), 12-16.

https://doi.org/10.1097/01.jaa.0000552718.90865.53