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Spinal immobilisation

Thomas Adam Purvis, Brian Carlin, Peter Driscoll
INTRODUCTION: The routine practice of pre-hospital spinal immobilisation (phSI) for patients with suspected spinal injury has existed for decades. However, the controversy surrounding it resulted in the 2013 publication of a Consensus document by the Faculty of Pre-Hospital Care. The question remains as to whether the quality of evidence in the literature is sufficient to support the Consensus guidelines. This critical review aims to determine the validity of current recommendations by balancing the potential benefits and side effects of phSI...
January 26, 2017: American Journal of Emergency Medicine
Lisa N Sharwood, Ralph Stanford, James W Middleton, Brian Burns, Anthony Joseph, Oliver Flower, Oran Rigby, Jonathon Ball, Shelly Dhaliwal
INTRODUCTION: Around 300 people sustain a new traumatic spinal cord injury (TSCI) in Australia each year; a relatively low incidence injury with extremely high long-term associated costs. Care standards are inconsistent nationally, lacking in consensus across important components of care such as prehospital spinal immobilisation, timing of surgery and timeliness of transfer to specialist services. This study aims to develop 'expertly defined' and agreed standards of care across the majority of disciplines involved for these patients...
January 19, 2017: BMJ Open
Andréane Richard-Denis, Cynthia Thompson, Jean-Marc Mac-Thiong
Individuals with spinal cord injury are at risk of sacral pressure ulcers due to, among other reasons, prolonged immobilisation. The effectiveness of a multi-layer foam dressing installed pre-operatively in reducing sacral pressure ulcer occurrence in spinal cord injured patients was compared to that of using a gel mattress, and stratified analyses were performed on patients with complete tetraplegia and paraplegia. Socio-demographic and clinical data were collected from 315 patients admitted in a level-I trauma centre following a spinal cord injury between April 2010 and March 2016...
January 4, 2017: International Wound Journal
P Tropiano, H Giorgi, A Faure, B Blondel
Lumbo-sacral (L5-S1) fusion is a widely performed procedure that has become the reference standard treatment for refractory low back pain. L5-S1 is a complex transition zone between the mobile lordotic distal lumbar spine and the fixed sacral region. The goal is to immobilise the lumbo-sacral junction in order to relieve pain originating from this site. Apart from achieving inter-vertebral fusion, the main challenge lies in the preoperative determination of the fixed L5-S1 position that will be optimal for the patient...
December 30, 2016: Orthopaedics & Traumatology, Surgery & Research: OTSR
Ala'a O Oteir, Karen Smith, Johannes U Stoelwinder, Shelley Cox, James W Middleton, Paul A Jennings
BACKGROUND: Traumatic Spinal Cord Injury (TSCI) is relatively uncommon, yet a devastating and costly condition. Despite the human and social impacts, studies describing patients with potential TSCI in the pre-hospital setting are scarce. This paper aims to describe the epidemiology of patients potentially at risk of or suspected to have a TSCI by paramedics, with a view to providing a better understanding of factors associated with potential TSCI. METHODS: This is a retrospective cohort study of all adult patients managed and transported by Ambulance Victoria (AV) between 01 January 2007 and 31 December 2012 who, based on meeting pre-hospital triage protocols and criteria for spinal clearance, paramedic suspicion or spinal immobilisation, were classified to be at risk of or suspected to have a TSCI...
December 2016: Injury Epidemiology
Florent Espitalier, Anne de Keating-Hart, Sylvain Morinière, Jean-Michel Badet, Nathalie Asseray, Christophe Ferron, Olivier Malard
PURPOSE: To highlight cervical spondylodiscitis as an infrequent complication following an invasive procedure on the neopharynx in patients previously treated with circumferential pharyngolaryngectomy with pectoralis major myocutaneous flap reconstruction. METHODS: Patients diagnosed with cervical spondylodiscitis after circumferential pharyngolaryngectomy between 2001 and 2013 were retrospectively studied using a questionnaire sent to the French head and neck tumour study group...
August 26, 2016: European Spine Journal
Aaron J Buckland, Silvia Bressan, Helen Jowett, Michael B Johnson, Warwick J Teague
OBJECTIVE: Evidence-based decision-making tools are widely used to guide cervical spine assessment in adult trauma patients. Similar tools validated for use in injured children are lacking. A paediatric-specific approach is appropriate given important differences in cervical spine anatomy, mechanism of spinal injury and concerns over ionising radiation in children. The present study aims to survey physicians' knowledge and application of cervical spine assessment in injured children. METHODS: A cross-sectional survey of physicians actively engaged in trauma care within a paediatric trauma centre was undertaken...
October 2016: Emergency Medicine Australasia: EMA
Manjul Tripathi, Narendra Kumar, Kanchan Kumar Mukherjee
BACKGROUND: Spinal radiosurgery is not considered in the domain of traditional Gamma Knife radiosurgery (GKRS) setup. The major obstacles in GKRS for upper cervical spine lesions remain in difficulty of frame fixation, avoiding collision and maintaining the integrity of the relative position of the lesion from image acquisition to treatment. METHODOLOGY: The supraorbital margin remains the standard lowest fixation point for Leksell stereotactic frame. We describe fixation at the maxilla to target and treat upper cervical spine lesions (up to C3 vertebra) with measures to ensure cervical immobilisation and precision of the GKRS treatment...
September 2016: Acta Neurochirurgica
M Y Goh, M S Millard, E C K Wong, D J Brown, A G Frauman, C J O'Callaghan
STUDY DESIGN: This is a prospective observational study. OBJECTIVES: The objective of this study was to determine time-dependent changes in diurnal blood pressure (BP) and urine production in acute spinal cord injury (SCI). SETTING: This study was conducted in a specialist, state-based spinal cord service in Victoria, Australia. METHODS: Consenting patients admitted consecutively with acute SCI were compared with patients confined to bed rest while awaiting surgery and with mobilising able-bodied controls...
January 2017: Spinal Cord
M Kettner
DIAGNOSTIC WORK-UP: The rescue, treatment and transport of patients with an injured spine require a systematic scheme with the subsequent rating of the findings and suspected diagnoses. In addition to the assessment of temporal urgency, the available resources and personnel, the duration and complexity of any possible technical measures that might be anticipated, the rational selection of immobilisation tools also plays a significant role. The most important medical rescue aids are the scoop stretcher and the spine board; the spine board, vacuum mattress and cervical collar are used to immobilise the patient...
August 2016: Der Radiologe
J T Oosterwold, D C Sagel, P M van Grunsven, M Holla, J de Man-van Ginkel, S Berben
BACKGROUND: Pre-hospital spinal immobilisation by emergency medical services (EMS) staff is currently the standard of care in cases of suspected spinal column injuries. There is, however, a lack of data on the characteristics of patients who received spinal immobilisation during the pre-hospital phase and on the adverse effects of immobilisation. The objectives of this study were threefold. First, we determined the pre-hospital characteristics of blunt trauma patients with suspected spinal column injuries who were immobilised by EMS staff...
June 8, 2016: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
(no author information available yet)
Assessment of trauma victims could be hampered by symptoms generated by immobilisation treatments. In a recent study, 21 healthy volunteers were spinally immobilised in the standard manner with a rigid cervical collar, taped and supported by sandbags on a long spinal board. The volunteers were immobilised for 30 minutes and then released.
May 1, 1994: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Baukje Hemmes, Cécile R L P N Jeukens, Aliaa Al-Haidari, Paul A M Hofman, Ed S Vd Linden, Peter R G Brink, Martijn Poeze
Trauma patients at risk for, or suspected of, spinal injury are frequently transported to hospital using full spinal immobilisation. At the emergency department, immobilisation is often maintained until radiological work-up is completed. In this study, we examined how these devices for spinal stabilization influence visual image quality. Image quality was judged for both patient CT scans and phantom CT scans. CT scans of 217 patients were assessed retrospectively by two radiologists for visual scoring of image quality, scoring both quantity and impact of artifacts caused by the immobilization devices...
June 2016: Emergency Radiology
A Germaneau, T Vendeuvre, M Saget, P Doumalin, J C Dupré, F Brémand, F Hesser, M Couvertier, C Brèque, P Maxy, M Roulaud, O Monlezun, P Rigoard
Kyphoplasty has been shown as a well-established technique for spinal injuries. This technique allows a vertebral bone augmentation with a reduction of morbidity and does not involve any adjacent segment immobilisation. There is a lack of biomechanical information resulting in major gaps of knowledge such as: the evaluation of the "quality" of stabilisation provided by kyphoplasty as a standalone procedure in case of unstable fracture. Our objective is to analyse biomechanical response of spine segments stabilised by Kyphoplasty and PMMA cement after experiencing burst fractures...
June 2016: Journal of the Mechanical Behavior of Biomedical Materials
Renee Finnigan, Brock Lamprecht, Tamara Barry, Kimberley Jones, Joshua Boyd, Andrew Pullar, Bryan Burmeister, Matthew Foote
INTRODUCTION: Stereotactic body radiotherapy (SBRT) for spinal tumours delivers high doses per fraction to targets in close proximity to neural tissue. With steep dose gradients, small changes in position can confer significant dosimetric impact on adjacent structures. We analysed positioning error in consecutively treated patients on a strict image-guidance protocol with online correction in 6 degrees of freedom (6-DOF). METHODS: Set-up error, residual error post-correction and intra-fraction motion for 30 courses of spinal SBRT in 27 patients were assessed using cone-beam CT...
February 2016: Journal of Medical Imaging and Radiation Oncology
Baukje Hemmes, Cécile R L P N Jeukens, Gerrit J Kemerink, Peter R G Brink, Martijn Poeze
Trauma patients at risk for, or suspected of, spinal injury are frequently transported to hospital using full spinal immobilisation. At the emergency department, immobilisation is often maintained until radiological work-up is completed. In this study, we examined how these devices influence radiation exposure and noise, as a proxy for objective image quality. Conventional radiographs (CR) and computer tomography (CT) scans were made using a phantom immobilised on two types of spineboard and a vacuum mattress and using two types of headblocks...
April 2016: Emergency Radiology
Mark Dixon, Joseph O'Halloran, Ailish Hannigan, Scott Keenan, Niamh M Cummins
BACKGROUND: Spinal immobilisation during extrication of patients in road traffic collisions is routinely used despite the lack of evidence for this practice. In a previous proof of concept study (n=1), we recorded up to four times more cervical spine movement during extrication using conventional techniques than self-controlled extrication. OBJECTIVE: The objective of this study was to establish, using biomechanical analysis which technique provides the minimal deviation of the cervical spine from the neutral in-line position during extrication from a vehicle in a larger sample of variable age, height and mass...
December 2015: Emergency Medicine Journal: EMJ
Enrique Guerado, Maria Luisa Bertrand, Luis Valdes, Encarnacion Cruz, Juan Ramon Cano
The term 'severely injured patient' is often synonymous of polytrauma patient, multiply-injured patient or, in some settings, polyfractured patient. Together with brain trauma, copious bleeding is the most severe complication of polytrauma. Consequently hypotension develop. Then, the perfusion of organs may be compromised, with the risk of organ failure. Treatment of chest bleeding after trauma is essential and is mainly addressed via surgical manoeuvres. As in the case of lesions to the pelvis, abdomen or extremities, this approach demonstrates the application of damage control (DC)...
2015: Open Orthopaedics Journal
Natalie Hood, Julie Considine
BACKGROUND: Spinal immobilisation has been a mainstay of trauma care for decades and is based on the premise that immobilisation will prevent further neurological compromise in patients with a spinal column injury. The aim of this systematic review was to examine the evidence related to spinal immobilisation in pre-hospital and emergency care settings. METHODS: In February 2015, we performed a systematic literature review of English language publications from 1966 to January 2015 indexed in MEDLINE and Cochrane library using the following search terms: 'spinal injuries' OR 'spinal cord injuries' AND 'emergency treatment' OR 'emergency care' OR 'first aid' AND immobilisation...
August 2015: Australasian Emergency Nursing Journal: AENJ
N V Todd, D Skinner, J Wilson-MacDonald
We assessed the frequency and causes of neurological deterioration in 59 patients with spinal cord injury on whom reports were prepared for clinical negligence litigation. In those who deteriorated neurologically we assessed the causes of the change in neurology and whether that neurological deterioration was potentially preventable. In all 27 patients (46%) changed neurologically, 20 patients (74% of those who deteriorated) had no primary neurological deficit. Of those who deteriorated, 13 (48%) became Frankel A...
April 2015: Bone & Joint Journal
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