Comparing the Efficacy of Long Spinal Board, Sked Stretcher, and Vacuum Mattress in Cervical Spine Immobilization; a Method-Oriented Experimental Study

Abstract

Introduction: Inadequate spinal motion restriction in patients suffering from spinal injuries could lead to further neurological damage, ultimately worsening their prognosis. This study aimed to investigate the efficacy of long spinal boards (LSB), ske stretcher, and vacuum mattress for cervical spine immobilization during transportation of patients by measuring the angular motion of the cervical spine following lifting, transferring, and tilting.

Methods: We conducted an experimental study using a box of three randomizations and crossover designs without a washout period effect for the long spinal board, sked stretcher, and vacuum mattress. We concealed the randomization with sequentially numbered, opaque, sealed envelopes (SNOSE). Kinematic data were collected using eight optoelectronic cameras at 200 Hz (BTS Bioengineering, Milan, Italy) in triangular planes (lateral bending, flexion-extension, and axial rotation) while performing all three motions (static lift-hold, transfer, and 90° tilt).

Results: 12 cases (7 males and 5 females) with the mean age of 20 ± 3.03 (range: 18-28) years were studied. The three highest angular motions were observed in the axial rotation plane during patient's tilting under immobilization on all devices (Vacuum mattress having the highest value of 99.01±8.93, followed by the LSB at 89.89±34.35 and the sked stretcher at 86.30±7.73 degrees). During patient lifting, a higher angular motion was observed with vacuum mattress immobilization in flexion extension (Coefficient = 4.45; 95%CI: 0.46 - 8.45; p =0.029) and axial rotation (Coefficient = 3.70; 95%CI: 0.58 - 6.81; p =0.020) planes. During patient transfer, a higher angular motion was observed with sked stretcher in the flexion-extension plane (Coefficient = 2.98; 95%CI: 0.11 - 5.84; p = 0.042). During patient tilting to 90 degrees, a higher angular motion was observed with vacuum mattress immobilization in lateral bending (Coefficient = -4.08; 95%CI: -7.68 - -0.48; p = 0.026) for the vacuum mattress.

Conclusion: Based on the finding of the present study, patients on the vacuum mattress experience significantly higher angular motion in flexion extension and axial rotation during lifting, as well as lateral bending during 90-degree tilting. In addition, patients on the sked stretcher showed significantly higher angular motion in flexion-extension during the transferring. However, the predictive margins for immobilization across all devices did not demonstrate clinically significant differences among the three immobilization devices.

Keywords: Cervical vertebrae; immobilization; motion; stretcher; vacuum mattress.

Figure 1

DX camera (left) and the reflective markers attached on the volunteer’s body (right)

Figure 2

Evaluating the three fixation devices, namely spinal board, sked strecher, and vacuum mattress during lifting, transfering and tilting of patients

Figure 3

Box plot of cervical angular motions based on immobilization devices

Figure 4

Margins plots of angular motion of flexion-extension and axial rotation planes during lifting after immobilization on long spinal board, sked stretcher and vacuum mattress. CI: confidence interval

Figure 5

Margins plots of angular motion of flexion-extension plane during transfer after immobilization on long spinal board, sked stretcher and vacuum mattress. CI: confidence interval

Figure 6

Margins plots of the relation between angular motion of lateral bending plane during tilting after immobilization on long spinal board, sked stretcher and vacuum mattress. CI: confidence interval