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Three Part Question

In [adult patients with suspected thoracolumbar trauma] is [complete spinal immobilisation neccessary] to [prevent further injury]

Clinical Scenario

A 25 year old male adult falls 4 ft and lands on his back. He comes into the Emergency Department complaining of lower back pain. He denies any pain in the neck region. The pateint has been completely immobilised by paramedics. On neurological examination NAD. Plain X-ray shows a Type A thoracolumbar burst fracture at the T12-L1 junction. You wonder whether further spinal immobilization is necessary in this patient

Search Strategy

Cochrane Database of Systematic Reviews 2nd Quarter 2007. Medline 1950 to June week 2 using the Ovid interface. EMBASE 1996 to 2007 week 25.
({exp spinal fractures} OR {exp thoracic vertebrae OR lumbar vertebrae} AND {exp immobilization OR spinal immobili$ mp.} AND {exp vacuum OR vacuum$ mp. OR vacuum splint$ mp. OR vacuum matress$ mp.} AND {back board$ mp. OR backboard$ mp. OR spin$ board$ mp.} LIMIT to humans and english language. LIMIT to "all adult (19 plus years)".

Search Outcome

6 papers were found of which 1 was relevant to the clinical question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses

Comment(s)

A Cochrane review concluded that there were no relavant randomised controlled trials. Evidence exists on the effects of different spinal immobilisation techniques but no evidence exist to quantify the effect of complete versus incomplete spinal immobilisation in trauma patients. A large RCT to quantify these effects in trauma patients is needed.

Clinical Bottom Line

The effect of complete verus incomplete spinal immobilisation on mortality, neurological injury, spinal stabiltiy and adverse outcome in trauma patients remains uncertain.

References

1. Kwan I, Bunn F, Roberts I Spinal immobilisation for trauma patients (review) Cochrane database of systematic reviews 2001;issue 2