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Cervical spine immobilisation and clearance
C spine immobilisation, halo ring insertion and clinical rules for clearing the cervical spine
11 questions3 source pages1 fact-check flags
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11 questions
Q1What are the degrees of immobilization provided by a rigid collar, SOMI and halo?▸
Rigid collar: F/E 70%, LF/R 30% (7-3-3)
SOMI: F/E 80%, LF 60%, R 30% (8-6-3)
Halo: F/E, LF, R 90% (9-9-9)
Q2Which cervical orthosis provides the greatest immobilization?▸
Halo provides the greatest immobilization
F/E, LF, R 90% (9-9-9)
Q3What are the complications of cervical spine immobilization?▸
Skin problems
Compliance
Increase ICP
Mandibular palsy
Aspiration
Q4How do you prepare and position the patient for halo ring insertion?▸
Prepare E trolley, assistant and ring of appropriate size
Rule out local C/I: skull fracture, infection, type IIA hangman fracture
Systemic C/I if using halo jacket: old age (20% mortality), obesity, barrel chest
Patient supine with head on head spoon at end of bed; temporary fixation of ring using positional pins; ring 1cm above skin
LA to pin site
Q5Where are the anterior pins placed and what are the dangers of malposition?▸
2 pins in front at lateral 2/3, 1cm above eyebrow, below equator; insert with eye closed
Too medial: supraorbital nerve, frontal sinus
Too lateral: thin temporal bone, temporal artery
Too superior: easy slip out
Q6How are the halo pins tightened?▸
2 posterior pins opposite the front pins, at the mastoid process
Tighten opposite pins together with 8 pound-inch pressure
Paediatric 4 pound; more pins 6-8
Retighten 48hr later (48 hours), then connect to traction
Q7What are the limitations of halo immobilisation?▸
Good for the upper cervical spine
Lower cervical spine: no good due to the snaking phenomenon
Q8What are the NEXUS criteria for cervical spine imaging?▸
Any one criterion warrants imaging
Decreased alertness
Intoxication
Distracting pain
Neurological deficit
Posterior midline C spine tenderness
Q9What do the Canadian C spine rules add?▸
Age 65
Mechanism of injury
Voluntary rotational range of motion >45 deg each side
Q10What are the different types of incomplete cord injury?▸
Central cord syndrome
Anterior cord syndrome
Posterior cord syndrome
Brown-Sequard syndrome
Conus medullaris and cauda equina syndromes
Q11What structures should be shown in a cross-section of the cervical spine?▸
Vertebral body and uncinate processes
Transverse foramen with vertebral artery and vein
Pedicles, laminae, spinous process, facet joints
Spinal canal with the spinal cord
Fact check
A rigid collar restricts lateral flexion/rotation by only 30%, and halo immobilization is 90% in all planes — contested/imprecise — Reported restriction varies widely with collar design and study; classic data on the Philadelphia collar show ~70% flexion-extension restriction but ~44% lateral bending and ~66% rotation, and halo values ~90% or more — (medium confidence) — source