Immobilization of the Spine

1
Immobilization of the Spine

• Suzanne L. Groah, MD, MSPH
• National Rehabilitation Hospital

2
Cervical Spine Immobilization

• Use of devices to stabilize the neck in a neutral
  position until adequate evaluation can be
  undertaken to determine the presence or absence
  of a cervical spine injury
• Neck immobilized at scene and until complete
  evaluation confirms no injury

3
Cervical Spine Immobilization

• Cervical spine immobilization must limit flexion
  and extension and side-to-side movement of the
  neck
• Soft collars permit 75 of normal neck movement
• Rigid collars (Philadelphia, etc) reduce flexion
  and extension to about 30 and rotation lateral
  movement to 50

4
Cervical Spine Immobilization

• Immobilization at scene
• Secure patient on hard board (head-foot)
• Place sandbags on either side of head
• Rigid collar
• Decreases movement to approx 5
• Special considerations in pediatrics

5
Cervical ROM

• Occiput C1 Flex/Ext
• C1 C2 50 of rotation of C-spine
• C5-C6 Flex/Ext
• C2-C4 Side bending and rotation
• T spine Limited mobility, FlexgtExt
• TL spine Lateral bending increases, axial
  rotation decreases
• L spine Flex/Ext

6
Cervical Orthoses Collars

• COs serve as a kinesthetic reminder to limit neck
  movement
• Soft collar
• Limits flex/ext by 5-15
• Limits lateral bending 5-10
• Limits rotation 10-17

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Cervical Orthoses

• Halo
• SOMI, molded MINERVA cervical orthosis
• ASPEN, Miami, PHILLY
• MNDA for weak extensors (ALS)
• Headmaster collar
• Soft collar

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Head Cervical Orthoses

• Include the occiput and chin to decrease range of
  motion (ROM)
• Skin breakdown
• Supported chin area (also ingrown hair in men)
• Clavicle
• Indications
• Stable spine conditions

9
Head Cervical Orthoses

• Philadelphia collar
• For C6-T2 injuries
• Anterior cervical fusion
• Halo removal
• Dens type I cervical fracture of C2
• Anterior diskectomy
• Suspected cervical trauma in unconscious patients
  
• Some tear-drop fracture of the vertebral body
• Cervical strain

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Cervical Thoracic Orthoses

• SOMI

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Sternal-Occipital-Mandibular-Immobilizer

• Rigid three-poster CTO with anterior chest plate
• Removable chin piece
• Ideal for bedridden patients since no posterior
  rods
• Relatively comfortable to wear
• Proper adjustment is crucial for motion
  restriction
• Motion restriction may be minimal with incorrect
  application
• Very effective in controlling flexion at the
  atlantoaxial and C2-C3 segments
• Indications
• Atlantoaxial instability because of RA
• Immobilization for neural arch fractures of C2

12
C-Collar Immobilization
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Cervical Immobilization Pearls

• All orthotics tend to control flexion better than
  extension
• Limitation of flexion at C1-C3
• Halo gt 4-poster gt CTO
• CTO are best at controlling flexion and extension
  at C3-T1
• SOMI brace is best at controlling flexion from
  C1-C5
• SOMI is less effective in controlling extension
• Limitation of rotation and lateral bending C1-C3
• Halo gt cervicothoracic brace

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Thoraco-Lumbar-Sacral Orthoses

• 3 point force application theory
• No true immobilization, just limitation of
  interspinous motion
• Limited sagittal control
• For effectiveness, must provide inhibitory
  feedback signal over bony prominences to reduce
  patient movement efforts