Cervical spine clearance

Background

• US and Canada with more than 13 million trauma pts per year at risk for C-spine injury
• Most blunt trauma patients will be placed in a cervical collar by EMS to protect the C-spine
• C-spine can be clinically cleared by trained personnel

Clinical Features

C-spine injuries may present with

• rarely neurogenic shock (bradycardia, hypotension)
• posterior neck pain
• pain on palpation of spinous processes
• limited neck ROM with pain
• weakness, numbness, or paresthesias

Decision Rules

NEXUS Cervical Spine Rule

Radiography is not necessary if the patient satisfies ALL of the following low risk criteria:

• No midline cervical tenderness
• No focal neuro deficits
• Normal alertness
• No intoxication
• No painful distracting injury

C-spine imaging should be considered unless the patient meets all of the above low risk criteria

Canadian Cervical Spine Rule

Algorithm for evaluation of cervical spine injuries (Canadian C-spine Rule)

No High Risk Factors

• Age >65
• Dangerous mechanism (fall>3ft/5 stairs, high speed MVC (>60mph)/rollover/ejection, bicycle crash, RV, axial load injury)
• Parasthesias in extremities

ANY Low Risk Factor

• Simple rear end MVC
• Delayed onset of pain
• Sitting position in ED
• Ambulatory at any time
• Absence of midline C-spine tenderness

ROM

• Rotates neck 45 degrees to left and right

C-spine can be cleared clinically if above criteria met

Canadian rule vs. Nexus

A single trial showed Canadian rule would pick up 312 or 313 clinically important cases, while NEXUS would miss 1 one in 10 cases

Sensitivity

Canadian 99.4% vs Nexus 90.7%

Specificity

Canadian 45.1% vs. Nexus 36.8%

Disposition

• based on imaging results

See Also

• Blunt neck trauma