An investigation of the range of cervical spine movements incurred during spinal immobilisation procedures

Author: Tim Pointon

Pointon, Tim, 2018 An investigation of the range of cervical spine movements incurred during spinal immobilisation procedures, Flinders University, College of Medicine and Public Health

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Objectives: Safety of out-of-hospital procedures used to manage patients with unstable spinal column injuries has never been effectively evaluated. In particular, literature evaluating the efficacy and safety of the log roll is sparse. This project evaluated the use of an inertia measurement unit (IMU) system to accurately report neck movement during a log roll manoeuvre. It also investigated the variation encompassed within the technique or associated with the experience of the operator.

Methods: To measure neck movement during a log roll, the IMU system was used to track the orientation of the head in relation to the thorax. Two head supporting techniques were employed during the log roll; the head and the shoulder hold. Thirty six participants performed 216 log rolls using both techniques. Participants were recruited from students, and practicing paramedics, forming novice and experienced groups respectively. Results were analysed using one-way ANOVA, linear regression models and visual examination of the plots. Ethics was obtained from the Flinders Clinical Research Ethics Committee.

Results: The average range of motion across all axes (lateral, flexion and rotation) was found to be 17.4º, which indicates a failure to maintain a neutral alignment, although the clinical significance of this is uncertain. Comparison of the shoulder hold and the head hold demonstrated the shoulder hold significantly reduced misalignment for rotation over the head hold. Significantly poorer performance by experienced participants compared with novice participants, ,both as lead clinicians directing the performance of the log rolls, was seen in the flexion axis. Linear regression analysis indicated that rotation values were higher than expected when compared with the other axes, with sharp spikes in misalignment at the commencement and conclusion of the manoeuvre.

Conclusions: This study validates the accuracy of the IMU system to use for neck movement studies. It also identified high angles of neck misalignment caused by the log roll which probably relates to participant coordination, spatial awareness and team synchronisation. While this misalignment was evident in all axes, the sharp spikes in rotational misalignment emphasised the problem with team synchronisation. Technique comparison indicated superiority of the shoulder hold over the head hold, but the magnitude of the difference was small. Performance difference between experienced and novice participants indicated a trend towards degradation of skills in experienced participants, although individual performance as a lead clinician may be influenced by the team’s performance. Further study is required to define an acceptable cervical alignment, determine improvements in techniques and address issues related to skills degradation.

Keywords: Spinal immobilisation, prehospital, cervical spine

Subject: Health Sciences thesis

Thesis type: Masters
Completed: 2018
School: College of Medicine and Public Health
Supervisor: Timothy Rayner