From the Guidelines
Assessment of cervical spine (C-spine) injuries should begin with a thorough history and physical examination, utilizing the NEXUS criteria or Canadian C-spine rules to determine the need for imaging, with CT scanning being the standard for suspected bony injury due to its superior sensitivity, as supported by the most recent study 1. The assessment process should include:
- A thorough history, noting the mechanism of injury, especially high-risk mechanisms like falls from height, high-speed motor vehicle accidents, diving accidents, or axial loading injuries
- Physical examination, including inspection for visible deformities, palpation for tenderness or step-offs, assessment of motor function in all extremities, sensory testing in all dermatomes, and evaluation of deep tendon reflexes
- Utilization of the NEXUS criteria or Canadian C-spine rules to determine the need for imaging, with criteria such as no midline cervical tenderness, no focal neurological deficit, normal alertness, no intoxication, and no painful distracting injury
- Radiographic assessment, typically beginning with plain X-rays including anteroposterior, lateral, and odontoid views, though CT scanning has become the standard for suspected bony injury due to its superior sensitivity, as noted in the study 1
- MRI is indicated when there are neurological deficits or suspicion of ligamentous, disc, or spinal cord injury, as supported by the study 1 During assessment, maintain cervical spine immobilization with a rigid collar until injury is ruled out, especially in unconscious patients or those with concerning mechanisms of injury, as this precaution prevents potential secondary injury to the spinal cord if instability exists, as highlighted in the study 1. Key considerations include:
- The NEXUS criteria have a 99.6% sensitivity for detecting clinically significant cervical injury, as noted in the study 1
- CT scanning has a superior sensitivity for detecting bony injuries, as supported by the study 1
- MRI is the modality of choice for evaluating soft-tissue injuries, including ligamentous, disc, or spinal cord injuries, as noted in the study 1
- Cervical spine immobilization is crucial in preventing secondary injury to the spinal cord, especially in unconscious patients or those with concerning mechanisms of injury, as highlighted in the study 1
From the Research
Assessment for Cervical Spine (C-Spine) Injury
The assessment for C-Spine injury involves several key considerations, including:
- Immobilization techniques to prevent further injury
- Diagnostic radiology and clinical evaluation to exclude CSI
- Airway and anesthetic management
Immobilization Techniques
Different immobilization techniques have been studied, including:
- Use of a spine board, head blocks, and immobilization straps with or without a cervical collar (CC) 2
- Use of a vacuum mattress with CC and head blocks 2
- Minimal immobilization using an ambulance cot, CC, pillow, and tape 2
- Combination of a rigid cervical collar and supportive blocks on a backboard with straps 3
Diagnostic and Clinical Evaluation
Diagnostic radiology and clinical evaluation are critical in assessing C-Spine injury, including:
- Medline search for English-language literature on spine trauma, cervical spine, and airway management after CSI 4
- Clinical evaluation to exclude CSI in conscious and cooperative patients 4
- Use of a benchmark called motionscore (MS) to interpret spinal movement 2
Airway and Anesthetic Management
Airway and anesthetic management are important considerations in patients with suspected CSI, including:
- Endotracheal intubation using the Bullard laryngoscope or oral intubation using a Macintosh blade after intravenous induction of anesthesia and muscle relaxation along with inline stabilization 4
- Maintenance of spinal immobilization to limit the risk of secondary neurological injury 4
Outcomes and Complications
The outcomes and complications of different immobilization strategies have been studied, including: