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Glenn R Rechtine - One of the best experts on this subject based on the ideXlab platform.
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comparison of the vacuum mattress versus the Spine Board alone for immobilization of the cervical Spine injured patient a biomechanical cadaveric study
Spine, 2017Co-Authors: Mark L Prasarn, Marybeth Horodyski, Per Kristian Hyldmo, Laura Ann Zdziarski, Evan M Loewy, Dewayne Dubose, Glenn R RechtineAbstract:Biomechanical cadaveric study. Trauma patients in the United States are immobilized on a rigid Spine Board, whereas in many other places vacuum mattresses are used with the proposed advantages of improved comfort and better immobilization of the Spine. We sought to determine the amount of motion generated in an unstable cervical Spine fracture with use of the vacuum mattress versus the Spine Board alone. Our hypothesis is that the vacuum mattress will better immobilize an unstable cervical fracture. Unstable subaxial cervical injuries were surgically created in five fresh whole human cadavers. The amount of motion at the injured motion segment during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). The measurements recorded in this investigation included maximum displacements during application and removal of the device, while tilting to 90 degrees, during a bed transfer, and a lift onto a gurney. Linear and angular displacements were compared using the Generalized Linear Model ANOVA for repeated measures for each of the 6 dependent variables (three planes of angulations and 3 axes of displacement). There was more motion in all six planes of motion during the application process with use of the Spine Board alone, and this was statistically significant for axial rotation (p = 0.011), axial distraction (p = 0.035), medial-lateral translation (p = 0.027), and anteroposterior translation (p = 0.026). During tilting there was more motion with just the Spine Board, but this was only statistically significant for anteroposterior translation (p = 0.033). With lifting onto the gurney there was more motion with the Spine Board in all planes with statistical significants, except lateral bending. During the removal process there was more motion with the Spine Board alone, and this was statistically significant for axial rotation (p = 0.035), lateral bending (0.044), and axial distraction (p = 0.023). There was more motion when using a Spine Board alone during typical maneuvers performed during early management of the Spine injured patient as compared to the vacuum mattress. There may be benefit of use of the vacuum mattress versus the Spine Board alone in preventing motion at an unstable, subaxial cervical Spine injury. Level of evidence: 2
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Study of Motion With Football Equipment in a Destabilized Cervical Spine Three Spine-Board Transfer Techniques
2016Co-Authors: Mark L Prasarn, Glenn R RechtineAbstract:Background: Numerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a Spine Board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a Spine Board. Purpose: To test 3 different transfer maneuvers of an injured football player onto a Spine Board to determine which method most effectively minimizes spinal motion in an injured cervical Spine model. Study Design: Controlled laboratory study. Methods: Five whole, lightly embalmed cadavers were fitted with shoulder pads and helmets and tested both before and after global instability was surgically created at C5-C6. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment during transfer. Spine-Boarding techniques evaluated were the log roll, the lift and slide, and the 8-person lift. Results: The 8-person lift technique resulted in the least amount of angular and linear motion for all planes tested as compared with the lift-and-slide and log-roll techniques. This reached statistical significance for lateral bending (P .031) and medial-lateral translation (P .030) when compared with the log-roll maneuver. The lift-and-slide technique was significantly more effective at reducing motion than the log roll for axial rotation (P .029) and lateral bending (P .006). Conclusion: The log roll resulted in the most motion at an unstable cervical injury as compared with the other 2 Spine-Boardin
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comparison of tissue interface pressure in healthy subjects lying on two trauma splinting devices the vacuum mattress splint and long Spine Board
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Mark N Pernik, Marybeth Horodyski, Glenn R Rechtine, Hudson Seidel, Ryan E Blalock, Andrew R Burgess, Mark L PrasarnAbstract:Abstract Background Most emergency transport protocols in the United States currently call for the use of a Spine Board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth. Methods To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3 kPa, and 3) maximal pressure (Pmax). Results In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3 kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. Pmax was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8 kPa, p Conclusion This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes.
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horizontal slide creates less cervical motion when centering an injured patient on a Spine Board
Journal of Emergency Medicine, 2016Co-Authors: Dewayne Dubose, Bryan P Conrad, Glenn R Rechtine, Mark L Prasarn, Laura Ann Zdziarski, Nicole Scott, Allyson Long, Marybeth HorodyskiAbstract:Abstract Background A patient with a suspected cervical Spine injury may be at risk for secondary neurologic injury when initially placed and repositioned to the center of the Spine Board. Objectives We sought to determine which centering adjustment best limits cervical Spine movement and minimizes the chance for secondary injury. Methods Using five lightly embalmed cadaveric specimens with a created global instability at C5–C6, motion sensors were anchored to the anterior surface of the vertebral bodies. Three repositioning methods were used to center the cadavers on the Spine Board: horizontal slide, diagonal slide, and V-adjustment. An electromagnetic tracking device measured angular (degrees) and translation (millimeters) motions at the C5–C6 level during each of the three centering adjustments. The dependent variables were angular motion (flexion-extension, axial rotation, lateral flexion) and translational displacement (anteroposterior, axial, and medial-lateral). Results The nonuniform condition produced significantly less flexion-extension than the uniform condition ( p = 0.048). The horizontal slide adjustment produced less cervical flexion-extension ( p = 0.015), lateral bending ( p = 0.003), and axial rotation ( p = 0.034) than the V-adjustment. Similarly, translation was significantly less with the horizontal adjustment than with the V-adjustment; medial-lateral ( p = 0.017), axial ( p p = 0.006). Conclusions Of the three adjustments, our team found that horizontal slide was also easier to complete than the other methods. The horizontal slide best limited cervical Spine motion and may be the most helpful for minimizing secondary injury based on the study findings.
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controlled laboratory comparison study of motion with football equipment in a destabilized cervical Spine three Spine Board transfer techniques
Orthopaedic Journal of Sports Medicine, 2015Co-Authors: Mark L Prasarn, Marybeth Horodyski, Bryan P Conrad, Christian P Dipaola, Matthew J Dipaola, Gianluca Del Rossi, Glenn R RechtineAbstract:BackgroundNumerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a Spine Board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a Spine Board.PurposeTo test 3 different transfer maneuvers of an injured football player onto a Spine Board to determine which method most effectively minimizes spinal motion in an injured cervical Spine model.Study DesignControlled laboratory study.MethodsFive whole, lightly embalmed cadavers were fitted with shoulder pads and helmets and tested both before and after global instability was surgically created at C5-C6. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment during transfer. Spine-Boarding techniques evaluated were the log roll, the lift and slide, and the 8-perso...
Marybeth Horodyski - One of the best experts on this subject based on the ideXlab platform.
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comparison of the vacuum mattress versus the Spine Board alone for immobilization of the cervical Spine injured patient a biomechanical cadaveric study
Spine, 2017Co-Authors: Mark L Prasarn, Marybeth Horodyski, Per Kristian Hyldmo, Laura Ann Zdziarski, Evan M Loewy, Dewayne Dubose, Glenn R RechtineAbstract:Biomechanical cadaveric study. Trauma patients in the United States are immobilized on a rigid Spine Board, whereas in many other places vacuum mattresses are used with the proposed advantages of improved comfort and better immobilization of the Spine. We sought to determine the amount of motion generated in an unstable cervical Spine fracture with use of the vacuum mattress versus the Spine Board alone. Our hypothesis is that the vacuum mattress will better immobilize an unstable cervical fracture. Unstable subaxial cervical injuries were surgically created in five fresh whole human cadavers. The amount of motion at the injured motion segment during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). The measurements recorded in this investigation included maximum displacements during application and removal of the device, while tilting to 90 degrees, during a bed transfer, and a lift onto a gurney. Linear and angular displacements were compared using the Generalized Linear Model ANOVA for repeated measures for each of the 6 dependent variables (three planes of angulations and 3 axes of displacement). There was more motion in all six planes of motion during the application process with use of the Spine Board alone, and this was statistically significant for axial rotation (p = 0.011), axial distraction (p = 0.035), medial-lateral translation (p = 0.027), and anteroposterior translation (p = 0.026). During tilting there was more motion with just the Spine Board, but this was only statistically significant for anteroposterior translation (p = 0.033). With lifting onto the gurney there was more motion with the Spine Board in all planes with statistical significants, except lateral bending. During the removal process there was more motion with the Spine Board alone, and this was statistically significant for axial rotation (p = 0.035), lateral bending (0.044), and axial distraction (p = 0.023). There was more motion when using a Spine Board alone during typical maneuvers performed during early management of the Spine injured patient as compared to the vacuum mattress. There may be benefit of use of the vacuum mattress versus the Spine Board alone in preventing motion at an unstable, subaxial cervical Spine injury. Level of evidence: 2
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comparison of tissue interface pressure in healthy subjects lying on two trauma splinting devices the vacuum mattress splint and long Spine Board
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Mark N Pernik, Marybeth Horodyski, Glenn R Rechtine, Hudson Seidel, Ryan E Blalock, Andrew R Burgess, Mark L PrasarnAbstract:Abstract Background Most emergency transport protocols in the United States currently call for the use of a Spine Board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth. Methods To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3 kPa, and 3) maximal pressure (Pmax). Results In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3 kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. Pmax was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8 kPa, p Conclusion This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes.
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horizontal slide creates less cervical motion when centering an injured patient on a Spine Board
Journal of Emergency Medicine, 2016Co-Authors: Dewayne Dubose, Bryan P Conrad, Glenn R Rechtine, Mark L Prasarn, Laura Ann Zdziarski, Nicole Scott, Allyson Long, Marybeth HorodyskiAbstract:Abstract Background A patient with a suspected cervical Spine injury may be at risk for secondary neurologic injury when initially placed and repositioned to the center of the Spine Board. Objectives We sought to determine which centering adjustment best limits cervical Spine movement and minimizes the chance for secondary injury. Methods Using five lightly embalmed cadaveric specimens with a created global instability at C5–C6, motion sensors were anchored to the anterior surface of the vertebral bodies. Three repositioning methods were used to center the cadavers on the Spine Board: horizontal slide, diagonal slide, and V-adjustment. An electromagnetic tracking device measured angular (degrees) and translation (millimeters) motions at the C5–C6 level during each of the three centering adjustments. The dependent variables were angular motion (flexion-extension, axial rotation, lateral flexion) and translational displacement (anteroposterior, axial, and medial-lateral). Results The nonuniform condition produced significantly less flexion-extension than the uniform condition ( p = 0.048). The horizontal slide adjustment produced less cervical flexion-extension ( p = 0.015), lateral bending ( p = 0.003), and axial rotation ( p = 0.034) than the V-adjustment. Similarly, translation was significantly less with the horizontal adjustment than with the V-adjustment; medial-lateral ( p = 0.017), axial ( p p = 0.006). Conclusions Of the three adjustments, our team found that horizontal slide was also easier to complete than the other methods. The horizontal slide best limited cervical Spine motion and may be the most helpful for minimizing secondary injury based on the study findings.
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controlled laboratory comparison study of motion with football equipment in a destabilized cervical Spine three Spine Board transfer techniques
Orthopaedic Journal of Sports Medicine, 2015Co-Authors: Mark L Prasarn, Marybeth Horodyski, Bryan P Conrad, Christian P Dipaola, Matthew J Dipaola, Gianluca Del Rossi, Glenn R RechtineAbstract:BackgroundNumerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a Spine Board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a Spine Board.PurposeTo test 3 different transfer maneuvers of an injured football player onto a Spine Board to determine which method most effectively minimizes spinal motion in an injured cervical Spine model.Study DesignControlled laboratory study.MethodsFive whole, lightly embalmed cadavers were fitted with shoulder pads and helmets and tested both before and after global instability was surgically created at C5-C6. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment during transfer. Spine-Boarding techniques evaluated were the log roll, the lift and slide, and the 8-perso...
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motion in the unstable cervical Spine when transferring a patient positioned prone to a Spine Board
Journal of Athletic Training, 2013Co-Authors: Bryan P Conrad, Gianluca Del Rossi, Glenn R Rechtine, Mark L Prasarn, Diana L Marchese, Marybeth HorodyskiAbstract:Context: Two methods have been proposed to transfer an individual in the prone position to a Spine Board. Researchers do not know which method provides the best immobilization. Objective: To determ...
Mark L Prasarn - One of the best experts on this subject based on the ideXlab platform.
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comparison of the vacuum mattress versus the Spine Board alone for immobilization of the cervical Spine injured patient a biomechanical cadaveric study
Spine, 2017Co-Authors: Mark L Prasarn, Marybeth Horodyski, Per Kristian Hyldmo, Laura Ann Zdziarski, Evan M Loewy, Dewayne Dubose, Glenn R RechtineAbstract:Biomechanical cadaveric study. Trauma patients in the United States are immobilized on a rigid Spine Board, whereas in many other places vacuum mattresses are used with the proposed advantages of improved comfort and better immobilization of the Spine. We sought to determine the amount of motion generated in an unstable cervical Spine fracture with use of the vacuum mattress versus the Spine Board alone. Our hypothesis is that the vacuum mattress will better immobilize an unstable cervical fracture. Unstable subaxial cervical injuries were surgically created in five fresh whole human cadavers. The amount of motion at the injured motion segment during testing was measured using a Fastrak, three-dimensional, electromagnetic motion analysis device (Polhemus Inc., Colchester, VT). The measurements recorded in this investigation included maximum displacements during application and removal of the device, while tilting to 90 degrees, during a bed transfer, and a lift onto a gurney. Linear and angular displacements were compared using the Generalized Linear Model ANOVA for repeated measures for each of the 6 dependent variables (three planes of angulations and 3 axes of displacement). There was more motion in all six planes of motion during the application process with use of the Spine Board alone, and this was statistically significant for axial rotation (p = 0.011), axial distraction (p = 0.035), medial-lateral translation (p = 0.027), and anteroposterior translation (p = 0.026). During tilting there was more motion with just the Spine Board, but this was only statistically significant for anteroposterior translation (p = 0.033). With lifting onto the gurney there was more motion with the Spine Board in all planes with statistical significants, except lateral bending. During the removal process there was more motion with the Spine Board alone, and this was statistically significant for axial rotation (p = 0.035), lateral bending (0.044), and axial distraction (p = 0.023). There was more motion when using a Spine Board alone during typical maneuvers performed during early management of the Spine injured patient as compared to the vacuum mattress. There may be benefit of use of the vacuum mattress versus the Spine Board alone in preventing motion at an unstable, subaxial cervical Spine injury. Level of evidence: 2
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Study of Motion With Football Equipment in a Destabilized Cervical Spine Three Spine-Board Transfer Techniques
2016Co-Authors: Mark L Prasarn, Glenn R RechtineAbstract:Background: Numerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a Spine Board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a Spine Board. Purpose: To test 3 different transfer maneuvers of an injured football player onto a Spine Board to determine which method most effectively minimizes spinal motion in an injured cervical Spine model. Study Design: Controlled laboratory study. Methods: Five whole, lightly embalmed cadavers were fitted with shoulder pads and helmets and tested both before and after global instability was surgically created at C5-C6. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment during transfer. Spine-Boarding techniques evaluated were the log roll, the lift and slide, and the 8-person lift. Results: The 8-person lift technique resulted in the least amount of angular and linear motion for all planes tested as compared with the lift-and-slide and log-roll techniques. This reached statistical significance for lateral bending (P .031) and medial-lateral translation (P .030) when compared with the log-roll maneuver. The lift-and-slide technique was significantly more effective at reducing motion than the log roll for axial rotation (P .029) and lateral bending (P .006). Conclusion: The log roll resulted in the most motion at an unstable cervical injury as compared with the other 2 Spine-Boardin
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comparison of tissue interface pressure in healthy subjects lying on two trauma splinting devices the vacuum mattress splint and long Spine Board
Injury-international Journal of The Care of The Injured, 2016Co-Authors: Mark N Pernik, Marybeth Horodyski, Glenn R Rechtine, Hudson Seidel, Ryan E Blalock, Andrew R Burgess, Mark L PrasarnAbstract:Abstract Background Most emergency transport protocols in the United States currently call for the use of a Spine Board (SB) to help immobilize the trauma patient. However, there are concerns that their use is associated with a risk of pressure ulcer development. An alternative device, the vacuum mattress splint (VMS) has been shown by previous investigations to be a viable alternative to the SB, but no single study has explicated the tissue-interface pressure in depth. Methods To determine if the VMS will exert less pressure on areas of the body susceptible to pressure ulcers than a SB we enrolled healthy subjects to lie on the devices in random order while pressure measurements were recorded. Sensors were placed underneath the occiput, scapulae, sacrum, and heels of each subject lying on each device. Three parameters were used to analyze differences between the two devices: 1) mean pressure of all active cells, 2) number of cells exceeding 9.3 kPa, and 3) maximal pressure (Pmax). Results In all regions, there was significant reduction in the mean pressure of all active cells in the VMS. In the number of cells exceeding 9.3 kPa, we saw a significant reduction in the sacrum and scapulae in the VMS, no difference in the occiput, and significantly more cells above this value in the heels of subjects on the VMS. Pmax was significantly reduced in all regions, and was less than half when examining the sacrum (104.3 vs. 41.8 kPa, p Conclusion This study does not exclude the possibility of pressure ulcer development in the VMS although there was a significant reduction in pressure in the parameters we measured in most areas. These results indicate that the VMS may reduce the incidence and severity of pressure ulcer development compared to the SB. Further prospective trials are needed to determine if these results will translate into better clinical outcomes.
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horizontal slide creates less cervical motion when centering an injured patient on a Spine Board
Journal of Emergency Medicine, 2016Co-Authors: Dewayne Dubose, Bryan P Conrad, Glenn R Rechtine, Mark L Prasarn, Laura Ann Zdziarski, Nicole Scott, Allyson Long, Marybeth HorodyskiAbstract:Abstract Background A patient with a suspected cervical Spine injury may be at risk for secondary neurologic injury when initially placed and repositioned to the center of the Spine Board. Objectives We sought to determine which centering adjustment best limits cervical Spine movement and minimizes the chance for secondary injury. Methods Using five lightly embalmed cadaveric specimens with a created global instability at C5–C6, motion sensors were anchored to the anterior surface of the vertebral bodies. Three repositioning methods were used to center the cadavers on the Spine Board: horizontal slide, diagonal slide, and V-adjustment. An electromagnetic tracking device measured angular (degrees) and translation (millimeters) motions at the C5–C6 level during each of the three centering adjustments. The dependent variables were angular motion (flexion-extension, axial rotation, lateral flexion) and translational displacement (anteroposterior, axial, and medial-lateral). Results The nonuniform condition produced significantly less flexion-extension than the uniform condition ( p = 0.048). The horizontal slide adjustment produced less cervical flexion-extension ( p = 0.015), lateral bending ( p = 0.003), and axial rotation ( p = 0.034) than the V-adjustment. Similarly, translation was significantly less with the horizontal adjustment than with the V-adjustment; medial-lateral ( p = 0.017), axial ( p p = 0.006). Conclusions Of the three adjustments, our team found that horizontal slide was also easier to complete than the other methods. The horizontal slide best limited cervical Spine motion and may be the most helpful for minimizing secondary injury based on the study findings.
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controlled laboratory comparison study of motion with football equipment in a destabilized cervical Spine three Spine Board transfer techniques
Orthopaedic Journal of Sports Medicine, 2015Co-Authors: Mark L Prasarn, Marybeth Horodyski, Bryan P Conrad, Christian P Dipaola, Matthew J Dipaola, Gianluca Del Rossi, Glenn R RechtineAbstract:BackgroundNumerous studies have shown that there are better alternatives to log rolling patients with unstable spinal injuries, although this method is still commonly used for placing patients onto a Spine Board. No previous studies have examined transfer maneuvers involving an injured football player with equipment in place onto a Spine Board.PurposeTo test 3 different transfer maneuvers of an injured football player onto a Spine Board to determine which method most effectively minimizes spinal motion in an injured cervical Spine model.Study DesignControlled laboratory study.MethodsFive whole, lightly embalmed cadavers were fitted with shoulder pads and helmets and tested both before and after global instability was surgically created at C5-C6. An electromagnetic motion analysis device was used to assess the amount of angular and linear motion with sensors placed above and below the injured segment during transfer. Spine-Boarding techniques evaluated were the log roll, the lift and slide, and the 8-perso...
Gianluca Del Rossi - One of the best experts on this subject based on the ideXlab platform.
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motion in the unstable cervical Spine when transferring a patient positioned prone to a Spine Board
Journal of Athletic Training, 2013Co-Authors: Bryan P Conrad, Gianluca Del Rossi, Glenn R Rechtine, Mark L Prasarn, Diana L Marchese, Marybeth HorodyskiAbstract:Context: Two methods have been proposed to transfer an individual in the prone position to a Spine Board. Researchers do not know which method provides the best immobilization. Objective: To determ...
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total motion generated in the unstable cervical Spine during management of the typical trauma patient a comparison of methods in a cadaver model
Spine, 2012Co-Authors: Mark L Prasarn, Marybeth Horodyski, Bryan P Conrad, Gianluca Del Rossi, Dewayne Dubose, John Small, Haitao Zhou, Glenn R RechtineAbstract:Object The proper prehospital and inpatient management of patients with unstable spinal injuries is critical for prevention of secondary neurological compromise. The authors sought to analyze the amount of motion generated in the unstable thoracolumbar Spine during various maneuvers and transfers that a trauma patient would typically be subjected to prior to definitive fixation. Methods Five fresh cadavers with surgically created unstable L-1 burst fractures were tested. The amount of angular motion between the T-12 and L-2 vertebral segments was measured using a 3D electromagnetic motion analysis device. A complete sequence of maneuvers and transfers was then performed that a patient would be expected to go through from the time of injury until surgical fixation. These maneuvers and transfers included Spine Board placement and removal, bed transfers, lateral therapy, and turning the patient prone onto the operating table. During each of these, the authors performed what they believed to be the most commo...
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removing a patient from the Spine Board is the lift and slide safer than the log roll
Journal of Trauma-injury Infection and Critical Care, 2011Co-Authors: Marybeth Horodyski, Bryan P Conrad, Gianluca Del Rossi, Christian P Dipaola, Glenn R RechtineAbstract:Background:After Spine Board immobilization of the trauma victim and transport to the hospital, the patient is removed from the Spine Board as soon as practical. Current Advanced Trauma Life Support's recommendations are to log roll the patient 90 degrees, remove the Spine Board, inspect and palpate
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the effectiveness of extrication collars tested during the execution of Spine Board transfer techniques
The Spine Journal, 2004Co-Authors: Gianluca Del Rossi, Marybeth Horodyski, Timothy P Heffernan, Glenn R RechtineAbstract:Abstract Background context In the prehospital stages of emergency care, cervical collars are (supposedly) used to aid rescuers in maintaining in-line stabilization of the spinal column as patients with potential or actual injuries are shifted onto a Spine Board to achieve full spinal immobilization. Unfortunately, not a single study has examined the effectiveness of cervical collars to control motion during the execution of Spine-Board transfer techniques. Purpose To evaluate the controlling effect of three cervical collars during the execution of Spine-Board transfer techniques. Study design This was a repeated measures investigation in which a cadaveric model was used to test the effectiveness of the Ambu (Ambu, Inc., Linthicum, MD), Aspen (Aspen Medical Products, Inc., Long Beach, CA) and Miami J (Jerome Medical, Moorestown, NJ) collars during the execution of the log-roll (LR) maneuver and the lift-and-slide (LS) technique. Methods Six medical professionals executed the LR and the LS on five cadavers. An electromagnetic tracking device was used to capture angular movements generated at the C5–C6 vertebral segment during the execution of both transfer techniques. The types of motion that were analyzed in this study were flexion-extension, lateral flexion and axial rotation motion. To test the three cervical collars, an experimental lesion (ie, a complete segmental instability) was created at the aforementioned spinal level of the cadavers and sensors from the electromagnetic tracking device were affixed to the specified vertebrae to record the motion generated at the site of the lesion. Results Statistical tests did not reveal a significant interaction between the independent variables of this study (ie, transfer technique and collar type), lending no support to the notion that there may be a combination of collar and transfer technique that could theoretically offer added protection to the patient. Although there was a decrease in the amount of motion generated in every one of the planes of motion as a result of wearing each of the three collars, none of the changes that emerged proved to be significantly different. A significant difference was noted between the LR and LS techniques when the amount of lateral flexion and axial rotation motion generated with each of the procedures were compared. In both cases, execution of the LR maneuver resulted in significantly more motion. Conclusions The data presented here suggest that the collars tested in this study are functionally similar. It is recommended that this study be repeated with a larger sample size.
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Spine Board transfer techniques and the unstable cervical Spine
Spine, 2004Co-Authors: Gianluca Del Rossi, Marybeth Horodyski, Michael E Powers, Timothy P Heffernan, Ronald Siders, Denis Brunt, Glenn R RechtineAbstract:Study design A repeated-measures design using a cadaveric model was used in this preliminary investigation on the effectiveness of Spine-Board transfer techniques. Objectives To compare the amount of angulation (flexion-extension) motion that results at the cervical Spine during the execution of the log-roll maneuver and the lift-and-slide technique; and to examine how changes to the integrity of the cervical Spine impacts the amount of motion generated during the transfer process. Summary of background data Very little research has been performed to establish the efficacy of Spine-Board transfer techniques. Early studies have indicated that the log-roll maneuver may not be appropriate for transferring victims with thoracolumbar injuries. Also, there has not been a single study that has reported the impact of transfer techniques on the unstable cervical Spine. This lack of data necessitated the present study. Methods Four groups (with six participants each) were asked to execute the log-roll maneuver and the lift-and-slide technique on five cadavers. An electromagnetic motion analysis device was used to assess the amount of angulation motion generated at the C5-C6 segment during the execution of these transfer techniques. To examine how changes to the integrity of the cervical Spine impacts the amount of motion that is produced during the transfer process, flexion-extension motion was assessed under various conditions: across a stable C5-C6 segment, after the creation of a posterior ligamentous injury, and after a complete segmental injury. Results No significant differences in angulation motion were noted between transfer techniques. However, significant differences were noted between all three injury conditions. That is, as the severity of the injury increased, the average amount of angulation motion produced at the site of the lesion also increased, regardless of technique. Conclusion The participants of this study were able to restrict flexion-extension motion equally well with thelog-roll maneuver as with the lift-and-slide technique. However, more research is needed to fully ascertain the effectiveness of Spine-Board transfer techniques.
Inger B Schipper - One of the best experts on this subject based on the ideXlab platform.
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randomised clinical trial comparing pressure characteristics of pelvic circumferential compression devices in healthy volunteers
Injury-international Journal of The Care of The Injured, 2011Co-Authors: S P Knops, Esther M M Van Lieshout, Richard W Spanjersberg, P Patka, Inger B SchipperAbstract:Abstract Introduction The role of pelvic circumferential compression devices (PCCDs) is to temporarily stabilise a pelvic fracture, reduce the volume and tamponade the bleeding. Tissue damage may occur when PCCDs are left in place longer than a few hours. The aim of this randomised clinical trial was to quantify the pressure at the region of the greater trochanters (GTs) and the sacrum, induced by PCCDs in healthy volunteers. Materials and methods In a crossover study, the Pelvic Binder ® , SAM-Sling ® and T-POD ® were applied successively onto 80 healthy participants in random order. The pressure was measured using a pressure mapping system, with the volunteers in supine position on a Spine Board and on a hospital bed. Data were analysed using Mixed Linear Modelling. Results On a Spine Board, the pressure exceeded the tissue damaging threshold at the GTs and the sacrum. Pressure at the GTs was highest with the Pelvic Binder ® , and lowest with the SAM-Sling ® . Pressure at the sacrum was highest with the Pelvic Binder ® . The pressure at the GTs and sacrum was reduced significantly for all three PCCDs upon transfer to a hospital bed. Conclusion The results of this randomised clinical trial in healthy volunteers showed that patients with pelvic fractures, temporarily stabilised with a PCCD, are at risk for developing pressure sores. The pressure on the skin exceeded the tissue damaging threshold and is, besides PCCD type, influenced by BMI, waist size and age. Regardless with which PCCD trauma patients are stabilised, early transfer from the Spine Board is of key importance to reduce the pressure to a level below the tissue damaging threshold. Clinicians should be aware of the potential deleterious effects associated with the application of a PCCD, and every effort must be made to remove the PCCD once haemodynamic resuscitation has been established.
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randomised clinical trial comparing pressure characteristics of pelvic circumferential compression devices in healthy volunteers
Surgery and Traumatology, 2011Co-Authors: S P Knops, P Patka, E M M Van Lieshout, W R Spanjersberg, Inger B SchipperAbstract:textabstractIntroduction: The role of pelvic circumferential compression devices (PCCDs) is to temporarily stabilise a pelvic fracture, reduce the volume and tamponade the bleeding. Tissue damage may occur when PCCDs are left in place longer than a few hours. The aim of this randomised clinical trial was to quantify the pressure at the region of the greater trochanters (GTs) and the sacrum, induced by PCCDs in healthy volunteers. Materials and methods: In a crossover study, the Pelvic Binder®, SAM-Sling® and T-POD® were applied successively onto 80 healthy participants in random order. The pressure was measured using a pressure mapping system, with the volunteers in supine position on a Spine Board and on a hospital bed. Data were analysed using Mixed Linear Modelling. Results: On a Spine Board, the pressure exceeded the tissue damaging threshold at the GTs and the sacrum. Pressure at the GTs was highest with the Pelvic Binder®, and lowest with the SAM-Sling®. Pressure at the sacrum was highest with the Pelvic Binder®. The pressure at the GTs and sacrum was reduced significantly for all three PCCDs upon transfer to a hospital bed. Conclusion: The results of this randomised clinical trial in healthy volunteers showed that patients with pelvic fractures, temporarily stabilised with a PCCD, are at risk for developing pressure sores. The pressure on the skin exceeded the tissue damaging threshold and is, besides PCCD type, influenced by BMI, waist size and age. Regardless with which PCCD trauma patients are stabilised, early transfer from the Spine Board is of key importance to reduce the pressure to a level below the tissue damaging threshold. Clinicians should be aware of the potential deleterious effects associated with the application of a PCCD, and every effort must be made to remove the PCCD once haemodynamic resuscitation has been established.