SPINAL IMMOBILISATION

In catastrophic Spinal Cord Injury (SCI), emergency immobilisation on a back-board is intuitive, mandatory - and unproven.

Most personal injury lawyers keep a healthy distance from the high-risk business of medical malpractice litigation. Nevertheless, when the spine is unstable after serious accidental injury, the plaintiff or defence personal injury lawyer must address the question of exacerbation or reinjury during emergency response.

PRACTICE POINT

Particularly in catastrophic injury, defence will want to explore an actus novus interveniens

Many lawyers and not a few physicians are repeatedly surprised to find how few traditional medical interventions have proven benefit.

Research in Evidence-Based Medicine, giant-killer child of the 1990s, must be laborious and painstaking. The more conventional and traditional the treatment and the more serious the condition, the greater the potential ethical objection to research comparing intervention with non-intervention.

PRACTICE POINT

There is no empirical evidence for emergency rigid immobilisation over standard careful handling for severe blunt spinal injury

A number of recent medical research papers, mainly from the University of New Mexico, address fine-tuning of emergency spinal immobilisation.

Experiments on healthy volunteers refined strapping techniques¹ and demonstrated that vacuum mattress splints were somewhat inferior in immobilising the head², but superior in preventing both torso movement and slippage on sideways tilt², and were more comfortable³.

Enter an elegant "natural" experiment on the neurological outcome of university hospital patients with acute blunt spinal or spinal cord injury⁴. By retrospective chart review, the researchers compared 120 patients at the University of Malaya, none of whom had had emergency immobilisation, with the 334 patients at the University of New Mexico, all of whom did.

PRACTICE POINT

Neurological outcome was worse after emergency spinal immobilisation

The immobilised patients had more neurological disability. There is a 4% probability that the result arose by chance: this translates into a 2% probability that spinal immobilisation was beneficial in these circumstances.