Basic Principles of Spine Evaluation and Clearance
·
General
o
The entire
spine is immobilized during primary
survey.
o
Radiographic clearance of the
spine is not required before
emergent surgical procedures. Presence of a
spinal column injury is assumed until
excluded.
o
Secondary
and tertiary exams include examination of the spine for tenderness and testing
all motor roots, sensation, and reflexes.
o
Tertiary exams are
performed only on
alert and unimpaired patient without
distracting injuries and are deferred until 24 hours after
presentation OR when alert & unimpaired. .
o
If any spine fractures are found, entire spine
must be radiographed.
o
Patients with
radiographic injury will have
spine consultation for focused
pre-operative evaluation regarding relative instability and
severity of injury prior to intubation when possible.
o
Patients remain on
spine precautions until
spine is cleared.
·
Cervical
o Refer to “Pediatric Cervical spine Clearance” protocol for guideline.
o Refer to “Pediatric Cervical Collar
Fit Guide (Miami J).”
·
Thoraco-Lumbar
o CT scan of thoracic
and lumbar spines if there are clinical
findings on secondary
or tertiary exams or an unreliable
exam.
o Multi-detector CT-scan with reformatted axial collimation
is
superior to plain films.
o Radiographic Thoraco-Lumbar clearance is not needed
prior to OR for non-spine surgery.
o Thoracic
& Lumbar clearance may
however be required for some non-supine
positioning in the OR, depending upon
acuity and case type.
o
Tertiary exam is necessary
to clear thoracic and
lumbar spines.
References
1. ACS
Best Practice Guide for further information
2. Herman, M. et al. Pediatric Cervical Spine Clearance. A Consensus Statement and Algorithm from the
Pediatric Cervical Spine Clearance Working Group. J Bone Joint Surg Am. 2019; 101: e1 (1-9).
For
additional information, refer to general nursing guideline gNU-56 Patient
Immobilization and Spinal Cord Stabilization
Disclaimer
These guidelines are not intended as
a directive or to present a definitive statement of the applicable standard of
patient care. They are offered as an approach for quality assurance and
risk management and are subject to (1) revision as warranted by the continuing
evaluation of technology and practice; (2) the overall individual professional
discretion and judgment of the treating provider in a given patient
circumstance; and (3) the patient’s willingness to follow the recommended treatment.