Cervical Spine Instability and Equipment Use: A Comparison of Prehospital Transfer Procedures in a Cadaver Model.

Principle Investigator: MaryBeth Horodyski EdD, ATC/L

Institution: University of Florida, FL

Title: Cervical Spine Instability and Equipment Use: A Comparison of Prehospital Transfer Procedures in a Cadaver Model

Spinal disorders are one of the six research priorities identified in the Unified Research Agenda. Spinal injury is considered catastrophic because of the related mortality, morbidity and extreme cost associated with treatment. Critical issues of spinal care involve emergency treatment in the crucial moments following initial injury. Podolsky et al.25 reported that 3-25% of cervical spine injuries actually occur after the original traumatic event and are caused or exacerbated by improper handling during the early stages of management or patient transport. Therefore, traditional emergency care procedures such as spine-board transfer techniques come into question. Most of what is known about the kinetics of the unstable cervical spine has been gleaned from research examining airway management techniques, stabilization techniques and equipment removal procedures.

The main objective of this project is to determine to what extent spinal instability affects cervical spine movement caused by prehospital transfer procedures. All test conditions described below will be completed on cadavers with intact cervical spines and then with a complete segmental injury created at C5-C6. The specific aims are to assess the displacement, distraction and angular motion occurring at C5-C6 during 1) the log-roll maneuver (LR), lift-and-slide technique (LS), and The Motorized Spine Board (TMSB) transfer; 2) the application of cervical collars and the effectiveness of the collars to control neck motion during various transfer procedures; 3) spine-boarding procedures comparing two different hand positions of the “head” rescuer; and 4) prehospital procedures when a helmet and football shoulder pads are worn.

Five fresh cadavers will be tested to reflect more accurately the instabilities of a cervical trauma patient. A Fastrak three-dimensional system will be used to quantify the amount of segmental motion generated during the execution of the prehospital procedures. The research team will be instructed in spine-boarding procedures and cervical collar usage, followed by practice trials for each technique.

For all testing sessions, receivers from the Fastrak device will be affixed to vertebrae C5 and C6. The amount of motion during each movement will be recorded. Order of testing for prehospital procedures and collar type will be randomized. Statistical tests and post hoc analyses will be completed for the variables of interest. All statistical analyses will be performed using SPSS software. The results of this research will improve emergency management of spinal disorders and advance understanding of how the spine can be stabilized after an injury so that precipitation or exacerbation of neurological injuries can be avoided.