Basic Principles of Spine Evaluation and Clearance

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.