UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Pediatric cervical spine immobilization

Author
Alison Chantal Caviness, MD, MPH, PhD
Section Editor
Anne M Stack, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

Cervical spine injury is rare in children. It is primarily seen in children who sustain blunt trauma, occurring in 1 to 2 percent of such cases [1,2]. The injury may involve bones, ligaments, blood vessels, or the spinal cord, and must be rapidly recognized and treated to avoid permanent disability or death [3,4].

The cervical spine must be immobilized in any child who is suspected of having a cervical spine injury until the injury is excluded [5]. Immobilization should be established in the prehospital setting, or failing that, upon presentation to the healthcare facility. It should be continued until injury is ruled out clinically or radiographically [5]. An estimated 3 to 25 percent of patients with spinal cord injury develop neurologic deficits caused by manipulation during resuscitation or transport [1,3,6]. Extension of cervical cord injury can be avoided with proper immobilization and careful airway management [4].

Techniques for immobilization of the cervical spine are reviewed here. The evaluation of cervical spine injuries is discussed separately. (See "Evaluation of cervical spine injuries in children and adolescents".)

INDICATIONS FOR IMMOBILIZATION

The cervical spine must be immobilized if certain historical or physical examination features are present. Mechanisms of injury that are associated with a high risk of cervical spine injury include:

Severe force (eg, motor vehicle crash or fall)

         

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue Aug 25 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Riggins RS, Kraus JF. The risk of neurologic damage with fractures of the vertebrae. J Trauma 1977; 17:126.
  2. Patel JC, Tepas JJ 3rd, Mollitt DL, Pieper P. Pediatric cervical spine injuries: defining the disease. J Pediatr Surg 2001; 36:373.
  3. Podolsky S, Baraff LJ, Simon RR, et al. Efficacy of cervical spine immobilization methods. J Trauma 1983; 23:461.
  4. Garfin SR, Shackford SR, Marshall LF, Drummond JC. Care of the multiply injured patient with cervical spine injury. Clin Orthop Relat Res 1989; :19.
  5. Skellett S, Tibby SM, Durward A, Murdoch IA. Lesson of the week: Immobilisation of the cervical spine in children. BMJ 2002; 324:591.
  6. Bonadio WA. Cervical spine trauma in children: Part I. General concepts, normal anatomy, radiographic evaluation. Am J Emerg Med 1993; 11:158.
  7. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000; 343:94.
  8. Huerta C, Griffith R, Joyce SM. Cervical spine stabilization in pediatric patients: evaluation of current techniques. Ann Emerg Med 1987; 16:1121.
  9. Perry SD, McLellan B, McIlroy WE, et al. The efficacy of head immobilization techniques during simulated vehicle motion. Spine (Phila Pa 1976) 1999; 24:1839.
  10. Schriger DL, Larmon B, LeGassick T, Blinman T. Spinal immobilization on a flat backboard: does it result in neutral position of the cervical spine? Ann Emerg Med 1991; 20:878.
  11. Nypaver M, Treloar D. Neutral cervical spine positioning in children. Ann Emerg Med 1994; 23:208.
  12. Herzenberg JE, Hensinger RN, Dedrick DK, Phillips WA. Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous. J Bone Joint Surg Am 1989; 71:15.
  13. Spine and spinal cord trauma. In: Manual of Advanced Trauma Life Support, 7th ed, American College of Surgeons (Ed), Chicago 2004. p.177.
  14. De Lorenzo RA. A review of spinal immobilization techniques. J Emerg Med 1996; 14:603.
  15. De Lorenzo RA, Olson JE, Boska M, et al. Optimal positioning for cervical immobilization. Ann Emerg Med 1996; 28:301.
  16. Treloar DJ, Nypaver M. Angulation of the pediatric cervical spine with and without cervical collar. Pediatr Emerg Care 1997; 13:5.
  17. Curran C, Dietrich AM, Bowman MJ, et al. Pediatric cervical-spine immobilization: achieving neutral position? J Trauma 1995; 39:729.
  18. Aprahamian C, Thompson BM, Darin JC. Recommended helmet removal techniques in a cervical spine injured patient. J Trauma 1984; 24:841.
  19. Manix T. The tying game. How effective are body-to-board strapping techniques? JEMS 1995; 20:44.
  20. Gerling MC, Davis DP, Hamilton RS, et al. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Ann Emerg Med 2000; 36:293.
  21. Shatney CH, Brunner RD, Nguyen TQ. The safety of orotracheal intubation in patients with unstable cervical spine fracture or high spinal cord injury. Am J Surg 1995; 170:676.
  22. King C, Rappaport LD. Emergent endotracheal intubation. In: The Textbook of Pediatric Emergency Procedures, 2nd ed, King C, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.159.
  23. Sanchez JI, Paidas CN. Childhood trauma. Now and in the new millennium. Surg Clin North Am 1999; 79:1503.
  24. King BR, Hagberg CA. Managements of the difficult airway. In: The Textbook of Pediatric Emergency Procedures, 2nd ed, King C, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.233.