What is the neurology assessment in cervical (c) spine injury?

From the Guidelines

A thorough neurological assessment for cervical spine injury should begin with a focused evaluation of motor function, sensory perception, and reflexes, as outlined in the most recent guidelines 1. The assessment should include testing motor strength in all extremities using the 0-5 scale, paying particular attention to grip strength, finger abduction, and lower extremity movement patterns.

• Assess sensory function by checking light touch, pinprick sensation, and proprioception in all dermatomes.
• Test deep tendon reflexes including biceps (C5-6), triceps (C7), and patellar (L2-4) reflexes, noting any hyperreflexia or hyporeflexia.
• Evaluate for pathological reflexes such as Hoffman's sign and Babinski reflex, which may indicate upper motor neuron damage.
• Check for signs of neurogenic shock including hypotension with bradycardia rather than tachycardia.
• Document any priapism in male patients, which can indicate severe cord injury.
• Assess for specific cord syndromes such as central cord syndrome (greater weakness in upper than lower extremities), Brown-Séquard syndrome (ipsilateral motor weakness with contralateral pain/temperature loss), or anterior cord syndrome (motor and pain/temperature loss with preserved proprioception), as these can guide immediate management decisions and establish a baseline for monitoring neurological changes 1. This comprehensive assessment is crucial in determining the level and severity of injury, and it is supported by the most recent evidence 1, which emphasizes the importance of a thorough neurological evaluation in patients with suspected or confirmed cervical spine injury.

From the Research

Neurology Assessment in Cervical Spine Injury

The neurology assessment in cervical spine injury is crucial to prevent further neurological damage. The following points highlight the key aspects of neurology assessment:

• The cervical spine is a fragile structure that can be associated with potentially catastrophic neurological complications in the event of an injury 2.
• Early diagnosis of cervical spine injuries is essential to optimize outcomes, and routine immobilization of the c-spine in all trauma patients is recommended 2.
• A high degree of suspicion for cervical spine injury is necessary to ensure early stabilization and prevent further neurological damage 3.
• Diagnostic radiology and clinical evaluation are critical in excluding cervical spine injury in conscious and cooperative patients 3.

Diagnostic Approaches

The diagnostic approaches for cervical spine injury include:

• Clinical evaluation to assess neurological function and identify potential spinal cord injuries 3, 4.
• Diagnostic radiology, such as imaging studies, to confirm the presence of a cervical spine injury 3, 5.
• The use of scoring systems, such as the international standards for neurological and functional classification of spinal cord injury, to assess neurological function 4.

Management and Treatment

The management and treatment of cervical spine injuries involve:

• Immobilization of the c-spine to prevent further injury, which can be achieved using rigid or soft collars 3, 5, 6.
• The use of high-dose methylprednisolone to reduce inflammation and improve neurological outcomes in acute cervical spinal cord injury 4.
• Surgical decompression may be necessary in some cases to relieve pressure on the spinal cord and improve neurological function 4.