Motion in the Unstable Cervical Spine When Transferring a Patient Positioned Prone to a Spine Board

Context:

Two methods have been proposed to transfer an individual in the prone position to a spine board. Researchers do not know which method provides the best immobilization.

Objective:

To determine if motion produced in the unstable cervical spine differs between 2 prone logrolling techniques and to evaluate the effect of equipment on the motion produced during prone logrolling.

Design:

Crossover study.

Setting:

Laboratory.

Patients or Other Participants:

Tests were performed on 5 fresh cadavers (3 men, 2 women; age = 83 ± 8 years, mass = 61.2 ± 14.1 kg).

Main Outcome Measure(s):

Three-dimensional motions were recorded during 2 prone logroll protocols (pull, push) in cadavers with an unstable cervical spine. Three equipment conditions were evaluated: football shoulder pads and helmet, rigid cervical collar, and no equipment. The mean range of motion was calculated for each test condition.

Results:

The pull technique produced 16% more motion than the push technique in the lateral-bending angulation direction (F_1,4 = 19.922, P = .01, η² = 0.833). Whereas the collar-only condition and, to a lesser extent, the football-shoulder-pads-and-helmet condition demonstrated trends toward providing more stability than the no-equipment condition, we found no differences among equipment conditions. We noted an interaction between technique and equipment, with the pull maneuver performed without equipment producing more anteroposterior motion than the push maneuver in any of the equipment conditions.

Conclusions:

We saw a slight difference in the motion measured during the 2 prone logrolling techniques tested, with less lateral-bending and anteroposterior motion produced with the logroll push than the pull technique. Therefore, we recommend adopting the push technique as the preferred spine-boarding maneuver when a patient is found in the prone position. Researchers should continue to seek improved methods for performing prone spine-board transfers to further decrease the motion produced in the unstable spine.Key Words: injuries, transfer techniques, logroll

Key Points

• A slight difference in motion was measured between the 2 prone logrolling techniques, with the push technique producing less lateral-bending and anterior-posterior motion than the pull technique.
• The logroll push technique should be adopted as the preferred spine-boarding maneuver when a patient is found in the prone position.
• Individuals who may need to perform this rescue procedure should practice and become proficient in the logroll push technique.
• Researchers should continue to seek improved methods for transferring patients positioned prone to spine boards to further reduce the motion transmitted to the unstable spine.

Each year, 12 000 incidents of nonfatal spinal cord injury are reported in the United States.¹ Approximately 8.0% of these injuries occur during sport participation.¹ Of all US sports, American football has by far the greatest number of spinal injuries. Between 1982 and 2007, the incidence of direct injuries in males playing American football was 1.89 per 100 000 participants in a college setting and 0.75 per 100 000 participants in a high school setting.²The prehospital management of spinal cord injuries is critical to prevent exacerbation of the injury. In 3% to 25% of patients, neurologic deterioration occurs during the initial management of spinal cord injuries.³ During immobilization and transportation of the patient to the hospital, precautions must be taken to transmit as little motion as possible to the spine. One of the first transfers that rescuers must perform is placing the injured athlete onto a long, rigid spine board. When the injured athlete is supine, lift-and-slide spine-board transfers produce less motion in the spine than logroll spine-board transfers.^4–6 However, when the patient is found in the prone position, a lift-and-slide transfer cannot be performed successfully, and a logroll technique must be used.Swartz et al⁷ recommended how to best manage a catastrophic spine injury in the athlete. They described 2 techniques for logrolling an athlete who is positioned prone: the prone logroll push and the prone logroll pull. Researchers⁸ have shown that the logroll push produces less motion in the unstable thoracolumbar spine. No one knows which of the prone spine-boarding techniques provides the best immobilization in the unstable cervical spine. Therefore, the primary purpose of our study was to determine if motion produced in the unstable cervical spine differs between 2 prone logrolling techniques. Our null hypothesis was that no difference would exist in the amount of motion allowed between the 2 prone logrolling techniques. Our secondary purpose was to evaluate the effect of equipment on the motion produced during the prone logrolling technique. Our null hypothesis was that no difference would exist in the amount of motion allowed among any of the equipment conditions.