Is our current method of cervical spine control doing more harm than good?

Early cervical spine immobilisation has long been considered the standard of care in the management of trauma patients with suspected spinal cord injury. There has been conflicting evidence regarding its benefits and risks. This article reviews the current literature and whether the continued use of routine cervical spine immobilisation is still appropriate in modern trauma care. A literature search was conducted using the Medline PubMed, Google Scholar and Cochrane Library online databases. The searches were limited to full text, English language studies conducted on adults in the last 20 years (July 1997 to July 2017). The entrenchment of cervical spine immobilisation in trauma management is multifactorial. In the pre-hospital setting, immobilisation is recommended whilst awaiting full assessment. Fear of missed diagnoses of spinal injuries encourages defensive medicine and over-immobilisation. Effective cervical spine immobilisation is appropriate in certain cases and reduces the risk of further spinal cord injury. However, research has shown that we are over-immobilising, and in penetrating trauma, cervical spine immobilisation increases the risk of mortality. The practice of routine cervical spine immobilisation for trauma patients is outdated, ineffective and results in iatrogenic injury. Routine cervical spine immobilisation is not backed up by robust evidence. It has been clearly shown that in cases of penetrating spinal injuries, cervical spine immobilisation is not only ineffective but is also linked to an increased risk of mortality. Special considerations must also be taken in patients who have pre-existing spinal conditions, impending airway compromise, or at risk of aspiration and those with head injuries or suspected traumatic brain injuries. A selective approach to cervical spine immobilisation is recommended and should be reserved for cases deemed high risk rather than a standard rule for all trauma patients