New Swedish guidelines for spinal motion restriction have been released by Wahlborg et al.! They are tailored to Swedish conditions and provide guidance on how to best manage suspected or confirmed spinal injuries in children, adults, and older trauma patients, both pre- and intra-hospital. Below, we have summarized their recommendations, but for the original source, please click here.
The recommendations for adults (individuals over 16 years old) include that patients where a spinal injury may be present should be managed with spinal motion restriction, but it should never delay or prevent life-saving measures. Movement should be minimized, and the restriction should be adapted to the patient, not the other way around. Cervical spinal motion restriction can be achieved manually or with external means, and a customized (two-part) treatment collar should be used after if radiologically verified spinal injury or when spinal injury has not been excluded. Investigation should primarily be done with a CT scan, with additional MRI for neurological deficits. Motion restriction should be terminated as soon as the patient has been cleared of significant spinal injury through clinical or radiological examination.
Special considerations when managing children include that those who meet physiological, anatomical, or injury mechanical criteria for significant trauma should be managed with spinal motion restriction as in adults until spinal injury can be clinically or radiologically excluded. Children in whom spinal injury may be present should be managed with spinal motion restriction by self-selected comfortable position on a soft mattress or in a bed. Children under three years of age can receive spinal motion restriction in a car seat, and children under nine years of age lying on their backs should have a pillow/elevation under their shoulders to avoid flexion of the neck due to the relatively large head. Children with syndromes require individual assessment.
Special considerations when managing older adults (individuals over 65 years old) include that they should be managed with spinal motion restriction by self-selected comfortable position on a soft mattress or in a bed, and that the restriction should be adapted to the patient.
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