Effectiveness of cervical spine stabilisation techniques

Background Proper stabilisation of suspected unstable spine injuries is necessary to prevent (worsen) spinal cord damage. Although the lift-and-slide (L&S) technique has been shown superior to the log-roll (LR) technique to place the body on the spinal board, no studies have yet compared different techniques of manual stabilisation of the c-spine itself. Objective To compare cervical motions that occur when trained professionals perform the Head Squeeze (HS) and Trap Squeeze (TS) c-spine stabilisation techniques. Design Cross-over. Setting and participants 12 experienced therapists. Assessment HS and TS during lift-and-slide (L&S) and LR placement on spinal board, and agitated patient trying to trying to sit up (AGIT-Sit) or rotate his head (AGIT-Rot). Main outcome measurements Peak head motion with respect to initial conditions using inertial measurement units attached to the forehead and trunk of the simulated patient. Comparisons between HS and TS with a priori minimal important difference (MID) of 5° for flexion or extension, and 3° for rotation or lateral flexion. Results Overall, the L&S technique was statistically superior to the LR technique. The only differences to exceed the MID were extension and rotation during LR (HS>TS). In the AGIT-Sit test scenario, differences in motion exceeded MID (HS>TS) for flexion, rotation and lateral flexion. In the AGIT-Rot scenario, differences in motion exceeded MID for rotation only (HS>TS). There was similar inter-trial variability of motion for HS and TS during L&S and LR, but significantly more variability with HS compared to TS in the agitated patient. Conclusion The L&S is preferable to the LR when possible for minimizing unwanted c-spine motion. There is little overall difference between HS and TS in a cooperative patient. When a patient is confused and trying to move, the HS is much worse than the TS at minimizing c-spine motion.