Spinal immobilisation

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> Prefaced by a lack of evidence in any direction (the reader is left to
> regard this as unsettling), they nonetheless suggest that spinal
> immobilization may result in preventable morbidity and 
> mortality via airway
> compromise.  They fail to admit that an absence of randomized 
> controlled
> trials is likely a reflection of the empirical value of spinal
> immobilization.  A superior study would require half of spine-injured
> patients to randomly go un-immobilized.  Love to see that 
> presented to the
> Human Subjects Committee.

This has been discussed before. Nobody has been able to find a case of lack
of immobilisation causing spinal injury. Current state of play is that that
is the best evidence.

> After seeing the discussion go both ways, I offer the following:
> 
> Spinal Immobilization incorporates the principle of fracture 
> management by
> immobilizing the joint above and the joint below an injury.
> 
> Due to the anatomy of the spinal column and the interaction 
> caused by forces
> affecting the spine, this principle should be extended.  
> Basically, the
> "joint above" the spine indicates that the head should be 
> immobilized, and
> the "joint below" indicates that the pelvis should be 
> immobilized. 

This is one of the problems. Spinal boards correctly applied prevent
movement between the skull, scapulae and pelvis. They do not prevent
movement between adjacent vertebrae parts of the same vertebra, (and their
application may even cause such movement). use of spinal boards is based on
dubious anatomical and physiological principles, with no clinical evidence.


> Hmm.  I think I follow.  Let me try one:
> 
> "Because serial killers are typically white males, and white 
> men comprise
> the majority of western neurosurgeons, there exists the 
> possibility that
> your local brain guy may have a freezer full of dismembered 
> prostitutes."

Thank you. I have long suspected this to be the case.


Matt Dunn


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