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Prehospital spinal and cervical motor restriction in adult trauma patients: a narrative review

Flavio Gheri, Niccolò Toppi, Nicola De Bortoli, Marco Forni, Simone Celi, Roberto Romano, Ilario Bocchi, Giuseppe Coraci, Domenica Petta, Douglas J. Floccare

Emergency Care Journal · 2025-09-22 · Other / unclear

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Abstract

The prehospital motor restriction of the cervical and spinal column in trauma patients remains a highly debated topic, with significant variability in clinical practice. With the present study, we aimed to conduct a narrative review of the literature on cervical and spinal motor restriction in prehospital settings, identifying devices used, clinical decision-making tools, and potential complications. A structured search was conducted in four databases (PubMed, ProQuest, CINAHL, Web of Science), including studies on adult trauma patients (≥16 years) with suspected spinal injury in prehospital settings. Screening was performed using Rayyan QCRI, and methodological quality was assessed via the Kmet checklist. A total of 28 studies were included. Evidence highlights that immobilization should not be applied routinely but guided by clinical risk and context. The use of validated protocols, selective motor restriction, and alternative devices (e.g., vacuum mattresses, self-extrication) may improve outcomes and reduce complications. High-fidelity simulation training and clinical audits are recommended to enhance decision-making and protocol adherence in spinal trauma management.

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Tags

Extrication · Spinal motion restriction

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