The effect of ATLS/PHTLS spinal motion restriction protocol on the incidence of spinal cord injury, a nationwide database study.

Purpose: To study trends in incidence and outcome of patients with traumatic spinal cord injury (TSCI) in the Netherlands before, during and after implementation of the Advanced Trauma Life Support (ATLS) and Pre-Hospital Trauma Life Support (PHTLS)- Spinal Motion Restriction(SMR) protocol.

Methods: In an observational database we studied national hospital admission and emergency department databases to analyse incidence rates and outcome of traumatic spinal cord injury and spinal fractures in the emergency department and in admittances in The Netherlands between 1986 and 2021.

Results: A significant increase of 39% in TSCI in admitted patients with spinal fractures over the past 35 years (p < 0.