PEDIATRIC CERVICAL-SPINE IMMOBILIZATION - ACHIEVING NEUTRAL POSITION

This study was designed to evaluate prospectively the ability of current spine-immobilization devices to achieve radiographic-neutral positioning of the cervical spine in pediatric trauma patients, All trauma patients who required spinal immobilization and a lateral cervical spine radiograph were included in the study, A lateral cervical spine radiograph was obtained while the child was immobilized, The Cobb angle (C-2-C-6,) was measured using a handheld goniometer. The method of immobilization, age at injury, and Cobb angle were compared. One hundred and eighteen patients with an average age of 7.9 years were enrolled, The majority were males (71%). The most frequent mechanisms of injury included motor vehicle accidents (35%) and falls (32%), The average Glascow Coma Scale score was 14, Although 31% of the children complained of neck pain, 92% were without neurologic deficits. The Cobb angles ranged from 27 degree kyphosis to 27 degree lordosis, and only 12 of the patients presented in a neutral position (0 degrees), Greater than 5 degrees of kyphosis orlordosis was observed in 60% of the children, Thirty-seven percent of the patients had 10 degrees or greater angulation, The most frequent methods of immobilization included a collar, backboard, and towels (40%), and a collar, backboard, and blocks (20%), but these techniques provided < 5 degrees kyphosis or lordosis in only 45% and 26% of the children respectively. No single method or combination of methods of immobilization consistently placed the children in the neutral position. From this data we concluded that (1) the majority of patients (60%) had cervical spine radiographs with greater than 5 degrees of kyphosis or lordosis; (2) a significant percentage (50%) of the children were in excessive flexion (> 5 degrees) and 30% had 10 degree kyphosis or greater; (3) achievement of 0 degrees radiographically was not related to patient age; (4) no single device or technique appears to provide superior protection from angulation of the cervical spine.