Immobilization of the cervical spine in the prehospital phase

Introduction: The immobilization of possible spinal injuries in the context of prehospital care has been controversially debated for years. In particular, immobilization of the cervical spine with so-called rigid C-spine orthoses (C-collars) has been at the center of controversy. This narrative review summarizes key statements from the spine chapter of the updated Clinical Practice Guideline (S3) on the Treatment of the Severely Injured (PG) and comments on them from the trauma surgeon's perspective.Materials and methods: The Ottawa method literature search for this PG did not identify any new evidence at the S3 level. Therefore, the core recommendations were confirmed as unchanged from the previous version. The basis of the commentary is a nonstructured literature search focusing on indication, procedure selection, and potential consequences.Results: The risk of cervical spine injury increases with increasing injury severity; therefore, spinal immobilization is indicated in multiple trauma patients. In this PG, C-collars have an unchanged value, even if no core recommendations are generally made on the procedure itself. Any residual mobility in the C-collar can be further reduced by positioning it on the vacuum mattress. Selective spinal immobilization based on individual risk assessment is mentioned but seems hardly applicable to the patient collective of this PG. Critical mention is made of the use of the C-collar in cases of traumatic brain injury with concurrent suspected cervical spine injury. Because of possible intracranial pressure peaks, alternative procedures for cervical spine immobilization are suggested here.Conclusion: In multiple trauma patients, there is a clear indication for cervical spine immobilization due to the increased risk of injury, especially in the cervical spine, with the aim of avoiding further damage, including damage caused by nonprofessional immobilization measures or omissions. Not the indication, but the preferred procedure remains the focus of controversial discussion, which cannot be conclusively conducted with the means of evidence-based medicine at present.