The Problem:
from Hyperbook of Neurosurgery
John Oro at University of Missouri
C-Spine Trauma Assessment Guidelines
- Clinically cleared
Patients who are awake, alert, not intoxicated and follow commands, may have their C-spine cleared on the basis of:
- no complaint of neck pain at rest
- no tenderness to palpation over the cervical vertebrae
- full, painless, active range of motion of the C-spine
C-spine X-rays are not necessary if the above 3 criteria are conscientiously sought and found to be present.
- Radiographically intact (3 views)
Patients who are not able to have their C-spine clinically cleared because of altered mental status
(eg. intoxicated, head injury, medicated, etc.) should have 3 C-spine X-rays:
- Lateral view showing down to C7-T1
- A-P view
- Open-mouth odontoid
If these films are good quality and show no fracture or dislocation, the patient should remain in a Philadelphia or equivalent collar until he/she may be clinically cleared (i.e. they become cooperative and reliable in regard to the C-spine clinical exam and are found to meet criteria for being cleared clinically). If the patient's state of unreliability is protracted (as in the case of closed head injury), cervical spine flexion/extension views can be taken using flouroscopy to rule out instability or the patient can be maintained in a collar until consciousness is regained.
- Radiographically suspicious
If a fracture is seen on any of the films, a CT scan should be performed. If the patient's status does not allow immediate further study, cervical immobilization is maintained until further study is possible.
- Flexion & Extension Views
Flexion and extension views are useful for excluding ligamentous injury in patients who have neck pain and no evidence of unstable injury on the screening films. Prior to obtaining flexion/extension radiographs, AP, lateral, and odontoid films of good quality (or a cervical CT scan) should be negative for fracture dislocation.
- Radiologic Evaluation of Cervical Spine Injuries
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What We Do:
The following algorithm summarizes the
initial radiologic evaluation of patients suspected of having spine injuries:
Treatment
Algorithm for
Cervical Spine Injuries |
| Neurologic Injury |
Skeletal Injury |
Pain / Tenderness |
Treatment |
| None |
None |
None |
Clear clinically |
| None |
None |
Present |
Flexion / extension films or
collar |
| Present |
None |
+/- |
MRI to look for herniated disc,
central cord syndrome, or epidural hematoma; treat accordingly |
| Present |
Present |
+/- |
Immobilize, MRI |
Links:
ABC's
of C-Spine Assessment for Trauma
Clearing the C-Spine
Evidence Footnotes:
1. reference
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