Biomechanical cadaveric study.
We sought to analyze the amount of motion generated in the unstable cervical spine during various maneuvers and transfers that a trauma patient would typically be subjected to prior to definitive fixation, using 2 different protocols.
From the time of injury until the spine is adequately stabilized in the operating room, every step in management of the spine-injured patient can result in secondary injury to the spinal cord.
The amount of angular motion between C5 and C6, after a surgically created unstable injury, was measured using an electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). A total sequence of maneuvers and transfers was then performed that a patient would be expected to go through from the time of injury until surgical fixation. This included spine board placement and removal, bed transfers, lateral therapy, and turning the patient prone onto the operating table. During each of these, we performed what has been shown to be the best and commonly used (log-roll) techniques.
During bed transfers and the turn prone for surgery, there was statistically more angular motion in each plane for traditional transfer with the spine board and manually turning the patient prone as commonly done (P < 0.01). During spine board placement, there was more motion in all 3 planes with log-rolling, and this reached statistical significance for axial rotation (P = 0.015) and lateral bending (P = 0.004). There was more motion during board removal with log-rolling in all 3 planes. This was statistically significant for lateral bending (P = 0.009) and approached significance in flexion-extension (P = 0.058) and axial rotation (P = 0.058). During lateral therapy, there was statistically more motion in flexion-extension and lateral bending with the manual log-roll technique (P < 0.001). The total motion was decreased by more than 50% in each plane when using an alternative to log-roll techniques during the total sequence (P < 0.006).
We have demonstrated the total angular motion incurred to the unstable cervical spine as experienced by the typical trauma patient from the field to stabilization in the operating room using the best compared with the most commonly used techniques. As previously reported, using log-roll techniques consistently results in unwanted motion at the injured spinal segment.
Patients with spinal injuries go through many movements prior to surgical stabilization. We analyzed the motion occurring at an unstable C5–C6 segment when going through such a sequence using best and commonly used (log-roll) techniques. The sum of greatest displacements was decreased by over half when avoiding log-roll techniques and turning the patient prone with the Jackson table turn.
*University of Rochester, Strong Memorial Hospital, Rochester, NY
†University of Florida, Gainesville, FL
‡University of South Florida, Tampa, FL; and
§University of Georgia, Augusta, GA.
Address correspondence and reprint requests to Mark L. Prasarn MD, Department of Orthopaedics and Rehabilitation, University of Texas, Memorial Hermann Hospital, 6400 Fannin Suite 1700, Houston, TX 77030; E-mail: firstname.lastname@example.org
Acknowledgment date: July 18, 2011. First revision date: September 7, 2011. Acceptance date: September 12, 2011.
The device(s)/drug(s) is/are FDA approved or approved by corresponding national agency for this indication.
Foundation funds were received to support this work.
No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.