Abstract
Immobilisation of the cervical spine is a common procedure following traumatic injury. This is often precautionary as the actual incidence of spinal injury is low. Nonetheless, stabilisation of the head and neck is an important part of pre-hospital care due to the catastrophic damage that may follow if further unrestricted movement occurs in the presence of an unstable spinal injury. Currently available collars are limited by the potential for inadequate immobilisation and complications caused by pressure on the patient’s skin, restricted airway access and compression of the jugular vein. Alternative approaches to cervical spine immobilisation are being considered, and the investigation of these new methods requires a standardised approach to the evaluation of neck movement. This review summarises the research methods and scientific technology that have been used to assess and measure cervical range of motion, and which are likely to underpin future research in this field. A systematic search of international literature was conducted to evaluate the methodologies used to assess the extremes of movement that can be achieved in six domains. 34 papers were included in the review. These studies used a range of methodologies, but study quality was generally low. Laboratory investigations and biomechanical studies have gradually given way to methods that more accurately reflect the real-life situations in which cervical spine immobilisation occurs. Latterly, new approaches using virtual reality and simulation have been developed. Coupled with modern electromagnetic tracking technology this has considerable potential for effective application in future research. However, use of these technologies in real life settings can be problematic and more research is needed.
Highlights
Serious injuries, those resulting from road traffic collisions, are increasing worldwide with more than one million deaths annually [1]
This practice is supported by widely accepted international trauma guidelines, such as those promoted in the “Advanced Trauma Life Support” (ATLS) course [2]
Shafer and Naunheim [6] recently reported a preliminary study in which a sixcamera motion capture system was used to examine cervical movement during mock extrications from a vehicle, suggesting that for conscious patients neck movement may be minimised by applying a cervical collar and inviting the patient to remove themselves from the car, rather than employing a more complex and time-consuming extrication technique
Summary
Those resulting from road traffic collisions, are increasing worldwide with more than one million deaths annually [1]. In many countries with developed pre-hospital and in-hospital trauma systems it is usual practice to apply a cervical collar to the neck of patients who have sustained blunt trauma, those with head injury, to reduce neck movement prior to definitive assessment. This practice is supported by widely accepted international trauma guidelines, such as those promoted in the “Advanced Trauma Life Support” (ATLS) course [2]. Shafer and Naunheim [6] recently reported a preliminary study in which a sixcamera motion capture system was used to examine cervical movement during mock extrications from a vehicle, suggesting that for conscious patients neck movement may be minimised by applying a cervical collar and inviting the patient to remove themselves from the car, rather than employing a more complex and time-consuming extrication technique
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