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‘Secondary spine injury’: how language affects future research and treatment

02 February 2017
Volume 9 · Issue 2

Abstract

Secondary spine injury can refer to neurologic deterioration resulting either from the clinical course of the original insult or from additional trauma. Early studies on the pre-hospital management of potential spinal injuries observed this distinction; later studies did not. This commentary argues a) that the convention of ascribing all cases of neurologic deterioration to additional movement or improper handling is unsupported, and b) that future research into best practices in the pre-hospital management of potential spinal injuries should adopt specific terminology to distinguish between the different senses of secondary spine injury.

The management of potential spine injuries is an important component of pre-hospital care. Sections on spinal assessment and treatment figure prominently in international trauma guidelines (American College of Surgeons Committee on Trauma, 2008; Campbell, 2011; Pons and McSwain, 2016), and it has been estimated that 5 million patients are transported with spinal immobilisation in the United States each year (Orledge and Pepe, 1998). Similar figures are not available for other countries, though rough estimates might be proportional to reported rates of traumatic spinal cord injury. This annual incidence varies widely by country, and is reported to be approximately 7.3 per million in the UK; 40 per million in the United States; 3.6 per million in Canada; and 15 per million in Australia (Jazayeri et al, 2015). A number of position papers and treatment guidelines currently advocate for a shift in treatment practices from uniform immobilisation to more flexible spinal motion restriction or spinal precautions (Connor et al, 2013; Morrissey et al, 2014; White IV et al, 2014). In this context of evolving standards, some of the basic assumptions about the harms and benefits of pre-hospital care are being reconsidered.

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