🦴 Chapter 141: Cervical Spine Stabilisation

Indications (trauma above clavicles, unconscious patient, high-risk mechanism) · Manual inline stabilisation · Cervical collars · Log-rolling · SCIWORA · Airway management in C-spine injury (jaw thrust only) · Children <8 years special considerations

🔍 Core Concepts: Cervical Spine Stabilisation

📌 Indications for C-spine immobilisation
Any trauma above clavicles, unconscious patient, high-risk mechanism (MVC, fall >standing height, diving, sporting accident).
🦴 SCIWORA (Spinal Cord Injury Without Radiological Abnormality)
Common in children (ligamentous laxity). Normal X-ray/CT but cord injury. MRI required. High index of suspicion.
🛡️ Manual inline stabilisation
Hold head in neutral position (aligned with torso). Avoid head tilt – use jaw thrust to open airway. Padding under occiput for children <8 years (relative large head).
📏 Cervical collars
Hard collar (size properly). Does NOT replace manual stabilisation. Risks: pressure ulcers, airway compromise, increased ICP.
🔄 Log-rolling
4-person manoeuvre: one holds head, three roll body. Minimise movement. Used to examine back and place spine board.
🚫 Contraindications to collar
Severe thoracic inlet injury (great vessels, tracheal injury) – maintain manual inline instead.
⚠️ Complications of prolonged immobilisation
Pressure injuries, difficulty swallowing, increased ICP, airway obstruction if vomiting.

🩺 Stepwise Cervical Spine Stabilisation in Trauma

1
Identify at-risk patients
Any trauma with mechanism above clavicles (head injury, facial trauma, neck injury), unconscious patient, high-speed MVC, fall >standing height, diving.
2
Apply manual inline stabilisation
Hold head with both hands, maintain neutral position (aligned with torso). Do not use head tilt – use jaw thrust for airway. Avoid traction or rotation.
3
Apply cervical collar (size appropriately)
Measure correctly (chin to sternal notch). Collar alone is insufficient – continue manual stabilisation during patient movement. Padding under occiput for children <8 years to avoid neck flexion.
4
Log-roll for back examination & spine board
4-person team: leader at head, three at chest/pelvis/legs. Roll in one piece, minimise movement. Place on spine board if needed for transport.
5
Clear C-spine when safe
Clinical clearance (NEXUS criteria): no midline tenderness, no neurological deficit, normal alertness, no intoxication, no distracting injury. If not clear, CT or MRI (for SCIWORA).