What are the emergency care recommendations for a cervical disc issue?

Emergency Care Recommendations for Cervical Disc Injury

In emergency situations involving suspected cervical disc injury, maintain spinal motion restriction by manually stabilizing the head to minimize movement of the head, neck, and spine while avoiding immobilization devices unless properly trained in their use. 1

Initial Assessment and Stabilization

When to Suspect Cervical Spine Injury

Suspect spinal injury if the patient has any of the following risk factors:

• Age ≥65 years
• Motor vehicle, motorcycle, or bicycle crash victim (driver, passenger, or pedestrian)
• Fall from greater than standing height
• Tingling in extremities
• Pain or tenderness in neck or back
• Sensory deficit or muscle weakness in torso or upper extremities 1

Immediate Stabilization

1. Manual stabilization is preferred over devices:

   • Manually stabilize the head to minimize motion of head, neck, and spine 1
   • Avoid immobilization devices by untrained personnel as they may cause harm 1
   • If immediate extrication is required (e.g., drowning victim), immobilization devices should only be used by properly trained personnel 1

2. If airway management is needed:

   • Use jaw thrust rather than head tilt plus chin lift when a simple maneuver is required 1
   • Remove the anterior portion of rigid cervical collars during intubation attempts to minimize cervical spine movement 1, 2
   • Consider videolaryngoscopy for intubation when available 1, 2
   • Use adjuncts such as stylet or bougie during intubation 1, 2

Common Pitfalls and Complications

Avoid These Common Mistakes

• Overreliance on rigid collars: Collars may not restrict displacement of unstable injuries and can cause paradoxical movement 2
• Prolonged immobilization: Can lead to pressure sores, increased intracranial pressure, and airway problems after 48-72 hours 2
• Improper airway management: Failing to use jaw thrust instead of head tilt can worsen injury 1
• Delayed diagnosis: Up to 4.3% of cervical fractures may be missed, with 67% of these patients suffering neurological deterioration as a result 2

Monitor For

• Respiratory compromise
• Neurological deterioration
• Signs of spinal shock
• Development of pressure sores with prolonged immobilization

Transport Considerations

• Maintain manual stabilization during transport 1, 3
• If trained personnel are available, a combination of rigid cervical collar and supportive blocks on a backboard with straps is effective in limiting cervical spine motion during transport 3
• The practice of using sandbags and tape alone for cervical spine immobilization is not recommended 3
• All trauma patients with potential cervical spine injury should be transported with appropriate spinal precautions 3

Evidence Quality Considerations

The evidence supporting emergency management of cervical disc injuries is generally of modest quality. The 2024 guidelines from multiple societies (Difficult Airway Society, Association of Anaesthetists, etc.) provide the most recent recommendations for airway management in patients with suspected cervical spine injury 1, while the 2010 American Heart Association and American Red Cross guidelines offer foundational recommendations for first aid providers 1.

The evidence suggests that manual stabilization is preferred over immobilization devices for untrained personnel, and that careful attention to airway management techniques is essential to prevent secondary injury to the cervical spine.