The ability of external immobilizers to restrict movement of the cervical spine: a systematic review

Abstract

Purpose To review the ability of various types of external immobilizers to restrict cervical spine movement. Methods With a systematical review of original scientific articles, data on range of motion, type of used external immobilization device and risk of bias were extracted. The described external immobilization devices were grouped and the mean restriction percentage and standard deviation were calculated. Finally, each device was classified based on its ability to restrict movement of the cervical spine, according to five levels of immobilization: poor (MIL \20 %), fair (MIL 20-40 %), moderate (MIL 40-60 %), substantial (MIL 60-80 %), and nearly complete (MIL C80 %). Results The ability to reduce the range of motion by soft collars was poor in all directions. The ability of cervicohigh thoracic devices was moderate for flexion/extension but poor for lateral bending and rotation. The ability of cervico-low thoracic devices to restrict flexion/extension and rotation was moderate, while their ability to restrict lateral bending was poor. All cranio-thoracic devices for non-ambulatory patients restricted cervical spine movement substantial in all directions. The ability of vests with non-invasive skull fixation was substantial in all directions. No studies with healthy adults were identified with respect to cranial traction and halo vests with skull pins and their ability to restrict cervical movement. Conclusions Soft collars have a poor ability to reduce mobility of the cervical spine. Cervico-high thoracic devices primarily reduce flexion and extension, but they reduce lateral bending and rotation to a lesser degree. Cervico-low thoracic devices restrict lateral bending to the same extent as cervico-high thoracic devices, but are considerably more effective at restricting flexion, extension, and rotation. Finally, cranio-thoracic devices nearly fully restrict movement of the cervical spine.

ResQbot 2.0: An Improved Design of a Mobile Rescue Robot with an Inflatable Neck Securing Device for Safe Casualty Extraction

“…Any unfavourable handling might aggravate injuries, particularly to the neck, head, and spinal cord (which includes the cervical spine). For this reason, medical professionals were consulted during all design stages of ResQbot 2.0, and a survey of the literature was carried out [48][49][50][51][52][53][54][55][56][57].…”

“…According to our literature review, it was found that spinal cord injuries and unstable fractures are some of the major concerns. Such injuries can occur either at the tetraplegic (the neck region) or paraplegic level (lower back region) [48][49][50][51][52][53][54][55][56][57]. Injuries at the tetraplegic level can cause impairment or loss of motor or sensory functions in the cervical segments of the spinal cord, affecting arms and legs [48].…”

“…However, recent work has illustrated that a cervical collar is not indispensable, and might even restrict a patient's airway [50,51]. Therefore, cranio-thoracic stabilisation methods, such as sandbags or stabilisation blocks that maintain the cervical spine straight without a cervical collar [52,53], have received increased attention.…”

Therapieempfehlungen zur Versorgung von Verletzungen der subaxialen Halswirbelsäule

“…B. Philadelphia-Orthese) zum Einsatz kommen. Eine ausführliche Übersicht über das Stabilisierungspotenzial der auf dem Markt befindlichen Zervikalorthesen bietet [16].…”

A Robotic Head Stabilization Device for Medical Transport

“…Should critical damage be present in the cervical spine, further motion could cause further injury or death. Research has shown that cranio-thoracic stabilization methods such as sandbags or stabilization blocks upon a stretcher can nearly completely stabilize the cervical spine, without the use of a cervical collar [7]. This thus forms the basis for the necessity and function of the proposed head stabilization device.…”