In-Hospital Cervical Spine Immobilization: Experimental Evaluation of Immobilization Devices

Background: In-hospital immobilization of the spine is a critical component of major trauma care, particularly to prevent secondary neurological injury of the cervical spine (C-spine). While prehospital recommendations are relatively consensual, evidence-based, standardized procedures for the in-hospital transition phase are lacking. Objective: To experimentally and quantitatively assess C-spine motion reduction under in-hospital conditions with four commonly used whole-body immobilization devices (long spine board, soft positioning mattress, TraumaMattress, vacuum mattress) and to investigate the effect of a stabilization pillow on a soft positioning mattress. Methods: In a standardized trauma-room scenario, C-spine movements (flexion/extension, rotation, lateral flexion) were recorded using inertial sensors (IMUs; Xsens® MTi 10) during transport and transfers and analyzed as motion scores for each axis and as total composite. An ancillary experiment tested the effect of a stabilization pillow on the soft positioning mattress. Results: The devices differed markedly in motion reduction. The total motion score was lowest for the spine board (122.0), followed by the TraumaMattress (138.7). The soft positioning mattress (238.7) and vacuum mattress (276.3) showed higher motion values. On the soft positioning mattress, the stabilization pillow primarily reduced rotation, with minimal increases in flexion/extension and lateral flexion; the overall effect remained small. Conclusions: Under experimental in-hospital conditions, the spine board and the TraumaMattress achieved the greatest reduction in C-spine motion. For clinical protocols, a standardized, patient-centered positioning strategy with reliable fixation appears reasonable; prospective clinical studies involving trauma patients are required for external validation.