I'm a spine surgeon at University of Texas. I help out with the Texans and the other pro sports teams in town. I got involved with a lab, started at University of Florida looking at prevention of worsening of cervical spine injuries and it's been kind of an interest of mine since. So some of this is research that we did. These are co-investigators from various institutions that we work with, mostly from University of Florida. So just kind of quickly, so there was some controversy about spinal immobilization a while ago. There was a push from emergency medicine and trauma surgeons get rid of backboarding and collars, but this is pretty antiquated and it wasn't really a very good study. So it looked at comparing accidents in New Mexico versus those in Malaysia of all places. And so just sort of comically, this is in Malaysia. This was in Marco Simonetti got in his accident there. He was a motorcycle driver and he actually died from his injuries and they dropped him trying to transport him. So obviously we don't want to be anything like this. And this is kind of what the comparison was from the United States to Malaysia saying spine boarding didn't do anything, right? So it's sort of ridiculous. But, you know, C-spine injuries aren't quite common. 2% of blunt trauma, not terribly common in the NFL, but, you know, bad things do happen. And, you know, we saw that this year and we need to be really critical of what we do and always practice the best practices we have. People do get worse. So the statistics are up to a third of patients with an unstable cervical spine injury will actually have neurologic decline, which could result in permanent quadriplegia, obviously. So big deal. We should limit movement patients as much as possible. I'm gonna kind of move quickly through this. This is an example of a kid I took care of in a motocross accident that became a complete quad after the care under healthcare providers. So again, it does happen up to a third of the time. I'm gonna argue that log rolling is suboptimal and this was looked at by Bob McGuire back in the 80s. He was a fellow at University of Miami where I trained. This goes way back to then. So taking this cadaver where we have motion sensors on, that's my mentor, Glenn Rectine, and dropping it on a hard concrete at six inches actually produces more motion than this log roll performed by four athletic trainers and Glenn Rectine himself. So we could do better. The better practice would be a six plus person lift and slide. I'm not sure what y'all do. In times you have to log roll. If the athlete's found prone, you really don't have much choice, right? But then the log roll. So at times you just do what's best but if they're supine or once you get them supine, it's probably better to do this. We've published a number of papers throughout the past two decades looking at all this stuff and then we looked at, this is sort of the best practices paper which I helped to write. And so basically we looked at the amount of cervical spine motion when moving a patient from field all the way to the operating room table. And again, there's some would argue that a patient has an unstable cervical injury, the damage is done. But again, I showed you that up to a third of the times are gonna get worse. We really don't want that obviously for the patient and obviously it looks really poorly on us as healthcare providers. And I would argue, we were talking about this before, sort of minimizing motion. Like yeah, there's not very much when you log roll somebody but it can be done better with the lift and slide as I mentioned and then all these other practices. So, basically did this a cadaveric study. We put collars on everybody and these were the sort of the motions we went through which be typically what would happen to somebody that's injured, taken to the hospital, went through scanners and then to the operating room if they needed surgery. And sort of this is just sort of a depiction and again, I'm gonna go with this briefly. So in the middle is the dark blue and then the pink is around that. The pink is log rolling. So through all those maneuvers, when you log roll somebody or you flip them prone onto a Jackson table without a Jackson turn, there's way more motion in all these planes. So basically conclusions of that overall study of everything is that there's significant displacement using log rolling. Total motion can be decreased by up to three times when you add all those things together and that log rolling is not the most protective method and there are better methods. I'm just gonna keep going and then just mention the collars. So collars can be problematic. Our ER doctors and trauma doctors don't really like them because when they're left in place too long, they can cause the acute desulcers, they can cause increased intracranial pressures for head injury patients. They do cause problems, but I think in the acute setting, there's no question that they're worthwhile. Again, the goal in any situations is to prevent neurologic decline and everybody with a suspected cervical injury should be placed in a hard cervical collar in my opinion. So we looked at, is it safe to apply collars and what kind? Same basic studies, looking at motion. The other thing about collars that I think people, what I value about collars the most is that they indicate that somebody has a potential cervical spine injury or they do have one and it reminds the providers around them to be careful with the neck and use cervical precautions. They probably don't have perfect immobilization, but nothing we talk about is perfect here, but the goal should be to strive for perfection and decrease the motion. So we looked at two different collars, one piece Sambu collar and a two piece Sierra collar. So we looked at both kinds and basically there's not a lot of motion when you take these on or put them on or take them off whatsoever. So end results, it is safe to apply collars. And again, I think the main benefit, I mean, it's standard of care, so you need to do it, but I think the main benefit is tells everybody, hey, be careful with this guy or girl's neck. So in conclusion, cervical injuries do occur. They are rare. There's Kevin Everett, I don't know if you all remember, DK Metcalf actually had a cervical jump facet when he was at Ole Miss. High-risk injuries require attention to detail and practice and planning. I can't emphasize the planning enough. There's been multiple talks on EAPs and rehearsing things and just having a plan. And we had a discussion last night about when's the best time to remove pads and Rob's gonna talk about that. It's really what you guys do best at your institutions or universities or with your teams. There are better practices, as I suggested, for moving patients or athletes and collars are safe and should probably be used. Thank you.

spine surgeon

cervical spine injuries

spinal immobilization

neurologic decline

cervical spine motion