[8] Some authors argue that use of spinal precautions is controversial because benefit is unclear and there are significant drawbacks including pressure ulcers, increased pain, and delayed transport times.

[3][4][7] Due to concerns of side effects the National Association of EMS Physicians and the American College of Surgeons recommend its use only in those at high risk.

[13] Spinal motion stabilization is not supported for penetrating trauma to the back including that caused by gun shot wounds.

[7] If intubation is required the cervical collar should be removed and neck stabilization provided by a trained staff member holding the patient's head.

[12][10][15] Multiple studies have demonstrated that current methods used to immobilize the spine in the field do not improve patient outcomes.

If the chosen decision rule (NEXUS or Canadian C-spine) is negative, or if cervical spine imaging is negative, the cervical collar can be removed if the patient does not have significant midline tenderness and can move the neck 45 degrees to both sides.

[6] If a patient cannot do both, the collar should be replaced and additional imaging or follow-up should be pursued depending on facility guidelines.

[6] Unfortunately, the NEXUS and Canadian C-Spine rules do not apply to suspected thoracic or lumbar injury; indeed, there are currently no validated guidelines for who requires imaging in this setting.

[12] In all patients with spinal cord injury, high-quality skin care to prevent pressure ulcers is essential.

[19] There is also debate that NSAID medications such as aspirin, ibuprofen, and naproxen may delay bone repair after spinal fusion or grafting, however there is some evidence that short-term use around the time of surgery is not associated with worse outcomes.

[18] Other activities that should be avoided until a provider permits them include soaking in water like a bathtub or hottub, sports (running, horseback riding, etc.

[8] For thoracic and lumbar spine, support can be provided using custom-fit, hard-shell back braces, most commonly after surgery.

[8] Spinal precautions including prehospital use of a backboard and cervical collar were first introduced in the United States in the 1960s.

[12] In the 1980s, spinal immobilization was initially used routinely for people who had experienced physical trauma, with little evidence to support its use.

[12] These studies led to the 2008 recommendation by the Consortium of Spinal Cord Medicine to only immobilize high-risk patients.