Biomechanical Motion Analysis of Cervical and Thoracolumbar Spine During Ambulance Transport: A Healthy Volunteer Study

David A. Wampler, Ronald M. Stewart, Rena Summers, Randall Schaefer, Lawrence Roakes, Craig Cooley, Mike Shown, Tasia Long, Chetan Kharod, Brian Eastridge

Abstract


Background: Recent evidence suggests that long spine board (LSB) may do little to manage spinal motion, and pose increased risk. This project sought to measure cervical and thoracolumbar motion during ambulance transport. The hypothesis was transport on a mattress with the head elevated without the LSB would allow less spinal movement than transport on an LSB.

Methods: A randomized healthy volunteer crossover trial measured spinal motion using biometric sensors. Positions analyzed included 0 and 10° on LSB. Stretcher alone with head elevated to 10°, 30°, 45° and 60°, with and without head blocks. Simulated ambulance transport was on city streets at or below posted speed limits.

Results: Nine subjects were included, with 66% being male. For cervical movement, there was no difference in axial, flexion/extension, or rotation (0.2 ± 0.1 mm vs. 0.2 ± 0.1 mm, 24 ± 12 mm vs. 22 ± 10 mm, and 5.1 ± 19° vs. 5.8 ± 20°, respectively). There were significant differences in lateral (3.7 ± 7 mm LSB vs. 2.0 ± 5 mm no LSB) movement and volumetric movement of the head (120 ± 172 mm3 LSB vs. 77 ± 86 mm3 no LSB). Positions allowing the lowest mean cervical volume of head movement were bed elevated to 30° and 45° with head blocks, (20 ± 22 mm3 and 12 ± 6 mm3, respectively). For thoracolumbar movement, there was no statistical difference in three-dimensional volumetric movement of the thoracolumbar spine (2 ± 0.6 mm3 LSB vs. 4.7 ± 5 mm3 no LSB).

Conclusion: Spinal motion was small in all groups. The stretcher mattress without LSB allowed less cervical motion than the LSB. Subjects secured to a stretcher mattress with head of the bed elevated to 30° had the least spinal movement.




J Neurol Res. 2020;10(3):73-79
doi: https://doi.org/10.14740/jnr587


Keywords


Spinal motion restriction; Prehospital medicine; EMS transport

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