Spinal Immobilization of Patients with Suspected TSCI in Pre Hospital Care Settings: A Scoping Review

Background: Traumatic spinal cord injury (TSCI) demands immediate intervention, with effective spinal immobilization essential to prevent further neurological damage. This review examines pre-hospital techniques for suspected TSCI, such as cervical collars, backboards, scoop stretchers, and manual stabilization. It emphasizes early identification, timely immobilization, and training for personnel. While no universal solution exists, evidence suggests a multimodal approach, integrating diverse techniques, may optimize outcomes for suspected TSCI. Materials and Methods: In this review study, published articles related Spinal Immobilization of patients with suspected TSCI were searched in library resources and Pubmed, ScienceDirect databases and Google Scholar Search Engine from ۲۰۱۴ to ۲۰۲۵. The keywords "Spinal Cord Injury, Immobilization Techniques, Prehospital, Emergencies" were used. The obtained articles were reviewed, evaluated and examined with the objectives of the study. In the primary search, ۱۵۲۰ articles were found. After removing articles without full-text and articles that were not related to the topic and duplicated articles, ۲۳ relevant articles were obtained. Results: The implementation of spinal motion restriction (SMR) protocols has significantly curtailed the pre-hospital use of long spinal boards (LSBS) in high-risk patients and those with confirmed spinal cord injuries. Research indicates that while spinal boards enhance patient comfort without compromising immobilization, pillows can further improve comfort and positioning. However, pillows are contraindicated in patients with unstable spines. Studies highlight the adverse effects of cervical collars in penetrating traumatic spinal cord injuries, linking their use to increased mortality, neurological complications, and diminished quality of care. This is likely due to rigid spinal immobilization in penetrating injuries obscuring critical clinical signs such as tracheal deviation and absent carotid pulse, thereby hindering successful endotracheal intubation. Conversely, evidence suggests that scoop stretchers offer superior patient comfort and reduced movement compared to traditional rigid backboards. Consequently, a multimodal approach, integrating diverse techniques, is recommended to optimize outcomes for individuals with suspected traumatic spinal cord injuries. Conclusion: Implementing spinal motion restriction (SMR) protocols effectively reduces the use of long spinal boards (LSB) in high-risk patients, though complete LSB elimination may be impractical. Gradual EMS adoption of SMR, alongside clear LSB usage guidelines, is crucial to optimize care and minimize complications. Individualized immobilization strategies, considering patient specifics and injury type, are paramount. In penetrating spinal injuries, meticulous technique is vital; scoop stretchers offer advantages over rigid backboards. While pillows enhance comfort, they are contraindicated in unstable spines. However adherence to pre-hospital SMR protocols is indispensable for preventing iatrogenic injuries.

کلیدواژه ها:

Spinal Cord Injury ، Immobilization Techniques ، Prehospital ، Emergencies