Canadian cervical spine rule


  • Only applies to GCS=15 and stable blunt neck trauma
  • Not applicable for:
    • Non-trauma, GCS <15, Hemodynamically unstable, Age <16, Acute paralysis, previous spinal disease or surgery


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


  • Rotates neck 45 degrees to left and right

C-spine can be cleared clinically if above criteria met[1] [2]


High Risk Rhyme

  • Sixty five,
  • Fast drive,
  • Sense deprive
  • (Image if alive)

Low Risk Rhyme

  • Slow wreck,
  • Slow neck,
  • Sitting down,
  • Walking around,
  • C-spine fine
  • (Range the spine)

See Also

External Links


  1. Stiell IG,et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001 Oct 17;286(15):1841-8. EBQ:Canadian C-spine Rule Study
  2. Stiell IG, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510-8.