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The Journal of Bone and Joint Surgery, Vol 71, Issue 1 15-22, Copyright © 1989 by Journal of Bone and Joint Surgery, Inc
Emergency transport and positioning of young children who have an injury of the cervical spine. The standard backboard may be hazardous
JE Herzenberg, RN Hensinger, DK Dedrick and WA Phillips
Section of Orthopaedic Surgery, University of Michigan, Ann Arbor 48109.
In ten children who were less than seven years old, an unstable injury of
the cervical spine was found to have anterior angulation or translation, or
both, on initial lateral radiographs that were made with the child supine
on a standard flat backboard. In all ten patients, extension was the proper
position for reduction of the injury of the cervical spine. Young children
have a large head in comparison with the rest of the body. When a young
child is positioned on a standard backboard, the neck may be forced into
relative kyphosis. Supine and upright lateral radiographs that were made of
seventy-two children who did not have a fracture also demonstrated more
relative cervical kyphosis in younger children when they were in the supine
position. Calculations from anthropometric data documented disproportionate
rates of growth of the head and the chest. The circumference of the head
grows logarithmically, but the circumference of the chest grows linearly.
This disproportionate growth causes young children to have a relatively
large head. When they lie supine, the neck is flexed. To prevent
undesirable cervical flexion in young children during emergency transport
and radiography, a standard backboard can be modified to provide safer
alignment of the cervical spine. This can be accomplished by the use of a
recess for the occiput to lower the head or of a double mattress pad to
raise the chest.
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