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Prehospital spinal immobilization and motion restriction strategies: A scoping review of the literature.

Federico Cucci, Dario Marasciulo, Roberto Lupo, Luana Conte, Giovanni Soldano, Cosimo Caldararo, Leonardo Zizzi, Emanuele Lagazzi, Michele Bonetti

Injury · 2026-01-09 · Scoping review

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Abstract

BACKGROUND: Prehospital management of suspected spinal injury has long relied on routine full immobilization. In recent years, several studies have questioned its benefit and highlighted possible adverse effects. The aim of this scoping review is to describe the evidence on the management of patients with suspected spinal injury, focusing on models based on full immobilization with rigid devices and a cervical collar, and on strategies of selective spinal motion restriction (SMR). METHODS: A scoping review was conducted according to JBI methodology and PRISMA-ScR guidance, with a protocol registered on the Open Science Framework. The literature search was carried out in the PubMed, Scopus and Web of Science databases. Studies on adults or children with suspected traumatic spinal injury managed in the out-of-hospital setting were included when strategies of full immobilization, selective SMR or no immobilization were described or compared. RESULTS: Twenty-seven studies met the inclusion criteria, including observational cohorts, experimental studies on volunteers, simulation studies and qualitative research. Overall, no clear advantage of routine full immobilization over more selective strategies emerges. Selective SMR based on clinical assessment and decision rules appears to reduce the use of rigid devices without evidence of increased missed unstable injuries. Prolonged immobilization is instead associated with pain, discomfort, alterations in tissue perfusion and greater use of imaging examinations. The overall body of evidence is heterogeneous and largely based on observational studies, in which the influence of confounding factors cannot be fully ruled out. CONCLUSIONS: The available evidence supports moving away from routine full immobilization towards selective SMR in the prehospital setting. Emergency medical services should update protocols and training accordingly and promote prospective studies focused on clinical outcomes and patient experience.

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Spinal motion restriction

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