Pre-hospital spinal immobilisation: an initial consensus statement
Spinal injuries are thankfully relatively uncommon but have the potential to cause very significant morbidity and mortality. It is reported that between 0.5% and 3% of patients presenting with blunt trauma suffer spinal cord injury (SCI) (Burney et al, 1993; Cameron et al, 2005). The incidence varies globally and time has yielded increased numbers of injuries annually. American figures estimate an incidence in the region of 40 cases per million per year (The National Spinal Cord Injury Statistic Center, 1997). In the UK, the majority of traumatic SCI are attributable to land transport (50%), followed by falls (43%), then sport (7%) (Aung and el Masry, 1997). Of those fractures causing SCI, half involve fractures of the cervical spine, with 37% due to thoracic spine injury and 11% due to lumbar spine injury. Of the C-spine, 50% occur at the C6/7 junction and a third at C2 (Spinal Cord Association, 2009). Data show a crossover rate in the region of 10%–15% of patients with a confirmed cervical fracture also having a thoracolumbar fracture (Winslow et al, 2006). It is well recognised that immobilisation is not without harm but the ‘number needed to treat’ in order to include one actual injury is high.
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