Original contribution
Spinal immobilization on a flat backboard: Does it result in neutral position of the cervical spine?

https://doi.org/10.1016/S0196-0644(05)81430-1Get rights and content

Study objectives:

To determine the amount of occipital padding required to achieve neutral position of the cervical spine when a patient is immobilized on a flat backboard. Neutral position was defined as the normal anatomic position of the head and torso that one assumes when standing looking straight ahead.

Design:

Descriptive with hypothesis testing of selected descriptive elements.

Setting:

University campus and hospital.

Subjects:

One hundred healthy young adults with no history of back disease.

Interventions:

Volunteers were measured in standing and supine positions.

Measurements:

Occipital offset; height; weight; and head, neck, and chest circumferences were measured for each subject.

Main results:

The amount of occipital offset required to achieve neutral position varied from 0 to 3.75 in. (mean, 1.5 in.). Mean occipital offset for men (1.67 in.) was significantly greater than that for women (1.31 in.) Easily obtained body measurements did not accurately predict occipital offset.

Conclusion:

Immobilization on a flat backboard would place 98% of our study subjects in relative cervical extension. Occipital padding would place a greater percentage of patients in neutral position and increase patient comfort during transport.

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    However, when a patient is placed in the supine position, the body habitus alters the cervical-thoracic angle and, as a result, it is believed that, in adults, padding beneath the head is necessary to obtain the so-called “neutral position” (5–7). Schriger et al. recommended an average of almost 4 cm (1.5 inches) of padding (7). McSwain et al. stated that more than 80% of adults require 1.3–5.1 cm (0.5–2.0 inches) of padding to achieve the neutral position (6).

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