Backboards in prehospital trauma: Assessing long-term neurological and spine-related disability among military personnel

BACKGROUND: Spinal motion restriction (SMR) has been widely implemented in prehospital trauma care since the 1960s, primarily via backboards, with the aim of minimizing secondary spinal cord injury during transport, particularly following blunt trauma. However, despite its widespread use, there is a paucity of evidence supporting the effectiveness of current SMR practices in improving clinical outcomes. Moreover, it remains inconclusive whether use of SMR can impact long-term disability following spinal trauma, particularly among healthy young individuals and in combat-related injuries. The aim of the study is to assess the short- and long-term service-connected disability among casualties immobilized following the use of backboards by Israel Defense Forces prehospital medical teams. METHODS: Using data from the Israel Defense Forces Trauma Registry, the study includes military personnel hospitalized with neck or spine injuries between 2006 and 2021. Patient data were cross-linked with the Israel National Trauma Registry and Israel Ministry of Defense Rehabilitation Department databases. The primary outcome was short- and long-term spinal service disability, and logistic regression models were used to assess demographic or injury-related variables associated with a disability. RESULTS: Among 445 eligible casualties, 192 (43.1%) were immobilized with a backboard. SMR recipients had higher injury severity scores and a greater proportion of severe injuries to the spine, head, thorax, abdomen, and extremities. No statistically significant differences were observed between SMR and non-SMR groups in the prevalence of long-term neurological disability. However, spine-related disability was more common in the SMR group (36.5% vs. 24.1%, p = 0.005). In an adjusted logistic regression analysis, SMR was not significantly associated with long-term neurological disability (adjusted odds ratio 1.41; 95% confidence interval 0.86-2.34; p = 0.176). CONCLUSIONS: Prehospital SMR with backboards was not associated with long-term neurologic disability among military personnel with spine and/or neck injuries. Taken together with existing evidence, these findings question the routine use of SMR in young, otherwise healthy trauma populations, and support a more selective approach to prehospital immobilization.