Spinal Cord Protection

Publication Date: December 1, 2019
Last Updated: March 14, 2022


Preferred Position for the Injured Spine

Neutral alignment should be restored and maintained using nonrigid tools during extrication, unless such a maneuver is met with resistance, increased pain, or new or worsening neurologic deficit. (1 – Strong, C)

Methods of Extrication With Possible Cervical Spine Injury

Patients requiring extrication should be encouraged to reduce movement of the neck, especially painful movement, and allowed to exit the situation under their own volition if alert and reliable. If injuries or other circumstances such as unconsciousness prevent controlled self-extrication, patients’ cervical spines should be packaged to reduce passive motion and the airway adequately managed without a goal of absolute immobilization. There is no requisite role for commercially made or improvised rigid cervical collars in an out-of-hospital environment. (1 – Strong, C)

Moving the Patient With Real or Potential Spine Injury

The lift and slide transfer with trap squeeze is preferred to the log-roll when transferring patients when motion restriction is desired. In the case of facial fractures, an unconscious patient, or other scenarios concerning for airway compromise, the lateral position may be considered. Light to moderate traction should be used when returning a cervical spine to the anatomic position and transferring a patient. (1 – Strong, C)

Effectiveness of Spinal Immobilization in Reducing the Incidence of Neurologic Sequelae

SCP should be considered an appropriate goal in patients with actual or suspected spinal injury; current evidence suggests SMR and not immobilization is the safest and most effective means of spinal cord protection (SCP). (2 – Weak, C)

Effectiveness of the Cervical Collar in Immobilization of the Cervical Spine

Commercial or improvised soft cervical collars should be considered one of several tools available to aid in reducing cervical spine motion, if that is a desired goal. It should not be used if the presence of the collar in itself compromises emergent patient care. There is no requisite role for rigid cervical collars in wilderness out-of-hospital trauma care. (2 – Weak, B)
If the medical history is known, use of any rigid cervical collar is contraindicated in ankylosing spondylitis. Patients with suspected injury should have their neck supported in a position of comfort. (1 – Strong, B)

Use of Backboard

Vacuum mattress provides superior motion restriction and improved patient comfort (with corresponding decreased risk of pressure sores) and is preferred over a backboard for motion restriction of either the entire spine or specific segments of concern. Backboards and other rigid carrying devices may be used for temporary patient movement if needed but should not be applied as a medical tool with an immobilization goal. (1 – Strong, C)

If SCP is desired, appropriately trained personnel, usig either the NEXUS criteria or the Canadian C-spine rule, can safely and effectively make decisions in the prehospital setting regarding whether cervical spine motion should be reduced. (1 – Strong, A)
If SCP is desired, a vacuum splint is preferable to a rigid collar. (1 – Strong, B)

Penetrating Trauma

Spinal immobilization should not be performed for isolated penetrating trauma. (1 – Strong, B)

Recommendation Grading




Spinal Cord Protection

Authoring Organization

Publication Month/Year

December 1, 2019

Last Updated Month/Year

June 9, 2022

Supplemental Implementation Tools

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Medical transportation

Intended Users

Paramedic emt, nurse, nurse practitioner, physician, physician assistant


Diagnosis, Prevention, Management, Treatment

Diseases/Conditions (MeSH)

D013116 - Spinal Cord


spinal cord, spinal motion restriction, spinal injury, cervical spine immobilization, Protection


Number of Source Documents
Literature Search Start Date
January 1, 1979
Literature Search End Date
August 1, 2019
Specialties Involved
Internal Medicine General, Sports Medicine