title: Is sub-occipital padding necessary to maintain optimal alignment of the unstable spine in the prehospital setting? A preliminary report.
abstract: BACKGROUND
  As prehospital emergency rescuers prepare cervical spine-injured adult patients for immobilization and transport to hospital, it is essential that patients be placed in a favorable position. Previously, it was recommended that patients with cervical spine injuries be immobilized in a slightly flexed position using pads placed beneath the head. However, it is unknown how neck flexion created with pad placement affects the unstable spine.
  
  
  OBJECTIVE
  To determine the effects of three different head positions on the alignment of unstable vertebral segments.
  
  
  METHODS
  Five cadavers with a complete segmental instability at the C5 and C6 level were included in the study. The head was either placed directly on the ground (or spine board) or on foam pads. Three conditions were tested: no pad; pads 2.84 cm thick; and pads 4.26 cm thick. Pads were positioned beneath the head to determine their effect on spinal alignment. Anterior-posterior translation, flexion-extension motion, and axial displacement across the unstable segment were compared between conditions.
  
  
  RESULTS
  Although statistical tests failed to identify any significant differences between pad conditions, some meaningful results were noted. In general, the "no pad" condition aligned the spine in a position that best replicated the intact spine.
  
  
  CONCLUSIONS
  Because the goal of emergency rescuers is to conserve whatever physiologic or structural integrity of the spinal cord and spinal column that remains, the outcome of this study suggests that this goal may be best achieved using the "no pad" condition. However, it is recommended that more research be conducted to confirm these preliminary findings.
authors.affiliation: Department of Orthopaedics and Sports Medicine, University of South Florida, Tampa, Florida 33612, USA.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Del Rossi
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Rechtine
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Conrad
authors.forename: MaryBeth
authors.initials: M
authors.lastname: Horodyski
mesh_terms: D000368:Aged; D002102:Cadaver; D002574:Cervical Vertebrae / Q000293:injuries*; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006801:Humans; D007103:Immobilization; D007593:Joint Instability / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D056888:Patient Positioning / Q000379:methods*; D014187:Transportation of Patients; D021801:Zygapophyseal Joint / Q000503:physiopathology
keywords: cervical spine; prehospital care; spinal immobilization