Introduction. Catastrophic neck injury is rare in rugby, however the consequences are invariably devastating. Schoolboys have previously been identified as a group at risk. This study came about as a result of a recent increase in admissions of schoolboy rugby players to the National spinal injuries unit in Glasgow. Aim. To audit schoolboy rugby admissions to spinal injury units throughout the United Kingdom and Ireland, in doing so to appraise the current state of data collection. To obtain estimates of playing numbers from the Home unions. Method. Retrospective review of all 12 spinal injury units for records of cases subsequent to 1996. Representatives of each of the four home unions were contacted to confirm cases and establish playing numbers. Results. Records were available from 1996 in Scotland and Ireland and from 2000 in England and Wales. Two units collect prospective data, two had easily retrievable data. In the absence of any register data retrieval was challenging elsewhere. Of the 36 cases 24 would be classified as catastrophic 12 as near misses. The median age for injury was 17. 51% of injuries occurred in the tackle, 35% in the scrum. 92% of scrum injuries involved neurological damage, 61% with complete neurological loss at presentation, 8% with no neurological injury. Tackle injuries were associated with neurological damage in 42%, 26% with complete lesions and no neurological injury in 57%. Estimates for playing numbers (U18 inclusive) approximate to Scotland 19,000, Wales 30,000, Ireland 40,000 and England 1,200,00. Conclusion. •. A persistent number of schoolboys were injured through the study period. •. Recording of serious neck injuries is inconsistent through the United Kingdom and Ireland. •. The numbers injured in Scotland were disproportionate in view of the relative playing populations. •. Whilst less frequent, scrum injuries were more often associated with spinal cord injury

Background. A cautious outlook towards neck injuries is the norm to avoid missing cervical spine injuries. Consequently there has been an increased use of cervical spine radiography. The Canadian Cervical Spine rule was proposed to reduce the unnecessary use of cervical spine radiography in alert and stable patients. Our aim was to see whether applying the Canadian Cervical Spine rule reduced the need for cervical spine radiography without missing significant cervical spine injuries. Methods. This was a retrospective study conducted in 2 hospitals. 114 alert and stable patients who had cervical spine radiographs done for suspected neck injuries were included in the study. Data on patient demographics, Canadian Cervical Spine rule, cervical spine radiography results and further visits after discharge were recorded. Results. 14 patients were included in the high risk category according to the Canadian Cervical Spine rule. 100 patients were assessed according to the low risk category. If the Canadian Cervical Spine rule was applied, there was a significant reduction in cervical spine radiographs (p<0.001) as 86/100 patients (86%) in the low risk category would not have needed cervical spine radiograph. 2/100 patients who had significant cervical spine injuries would have been identified when the Canadian Cervical Spine rule was applied. Conclusion. Applying the Canadian Cervical Spine rule for neck injuries in alert and stable patients reduced the use of cervical spine radiographs without missing out significant cervical spine injuries. This relates to reduction in radiation exposure to patients and cost benefits

The aim of the study was to highlight the absence of an important pitfall in the Advanced Trauma Life Support protocol in application of rigid collar to patients with potentially unstable cervical spine injury. We present a case series of two patients with ankylosed cervical spines who developed neurological complications following application of rigid collar for cervical spine injuries as per the ATLS protocol. This has been followed up with a survey of A&E and T&O doctors who regularly apply cervical collars for suspected unstable cervical spine injuries. The survey was conducted telephonically using a standard questionnaire. 75 doctors completed the questionnaire. A&E doctors = 42, T&O = 33. Junior grade = 38, middle grade = 37. Trauma management frontline experience >1yr = 50, <1yr = 25. Of the 75 respondents 68/75 (90.6%) would follow the ATLS protocol in applying rigid collar in potentially unstable cervical spine injuries. 58/75 (77.3%) would clinically assess the patient prior to applying collar. Only 43/75 (57.3%) thought the patients relevant past medical history would influence collar application. Respondents were asked whether they were aware of any pitfalls to rigid collar application in suspected neck injuries. 34/75 (45.3%) stated that they were NOT aware of pitfalls. The lack of awareness was even higher 17/25 (68%) amongst doctors with less that 12 months frontline experience. When directly asked whether ankylosing spondylitis should be regarded as a pitfall then only 43/75 (57.3%) answered in the affirmative. We would like to emphasise the disastrous consequences of applying a rigid collar in patients with ankylosed cervical spine. The survey demonstrates the lack of awareness (∼ 50%) amongst A&E and T&O doctors regarding pitfalls to collar application. We recommend the ATLS manual highlight a pitfall for application of rigid collars in patients with ankylosed spines and suspected cervical spine injuries

Cervical spine collars are applied in trauma situations to immobilise patients' cervical spines. Whilst movement of the cervical spine following the application of a collar has been well documented, the movement in the cervical spine during the application of a collar has not been. There is universal agreement that C-spine collars should be applied to patients involved in high speed trauma, but there is no consensus as to the best method of application. The clinical authors have been shown two different techniques on how to apply the C-spine collars in their Advanced Life Support Training (ATLS). One technique is the same as that recommended by the Laerdal Company (Laerdal Medical Ltd, Kent) that manufactures the cervical spine collar that we looked at. The other technique was refined by a Neurosurgeon with an interest in pre-hospital care. In both techniques the subjects' head is immobilised by an assistant whilst the collar is applied. We aimed to quantify which of these techniques caused the least movement to the cervical spine. There is no evidence in the literature quantifying how much movement in any plane in the unstable cervical spine is safe. Therefore, we worked on the principle: the less movement the better. The Qualisys Motion Capture System (Qualisys AB, Gothenburg, Sweden) was used to create an environment that would measure movement on the neck during collar application. This system consisted of cameras that were pre-positioned in a set order determined by trial and error initially. These cameras captured reflected infra-red light from markers placed on anatomically defined points on the subject's body. As the position of the cameras was fixed then as the patients moved the markers through space, a software package could deduce the relative movement of the markers to each camera with 6 degrees of freedom (6DOF). Six healthy volunteers (3 M, 3 F; age 21-29) with no prior neck injuries acted as subjects. The collar was always applied by the same person. Each technique was used 3 times on each subject. To replicate the clinical situation another volunteer would hold the head for each test. The movements we measured were along the x, y, and z axes, thus acting as an approximation to flexion, extension and rotation occurring at the C-spine during collar application. The average movement in each axis (x, y and z) was 8 degrees, 8 degrees and 5 degrees respectively for both techniques. No further data analysis was attempted on this small data set. However this pilot study shows that our method enables researchers to reproducibly collect data about cervical spine movement whilst applying a cervical collar