Authors: Jules Blackham, Jason M Kendall, Roland Watura / Editor: Jason B Lee / Reviewer: Emma Everett, Joe Schrieber / Codes: / Published: 11/10/2021
Cervical spine immobilisation is the most commonly performed procedure in pre-hospital care; it is not benign: it is associated with raised intracranial pressure in patients with head injury, pressure sores and impairment of respiratory function. Reliable and expedient strategies, clinical and/or radiological are required to exclude significant cervical spine injury.
After completing this session you will be able to:
- Describe the pathophysiology of cervical spine injury
- Link mechanism of injury to anatomical injury
- Perform a clinical assessment to exclude significant cervical spine injury
- Use appropriate clinical decision rules to exclude significant injury
- Recognise when radiological imaging is required to exclude significant injury
- Plan an appropriate imaging strategy for an individual patient
- Manage a patient with a potential cervical spine injury
References:
- Milby AH, Halpern CH, Guo W, et al. Prevalence of cervical spinal injury in trauma. Neurosurgical Focus 2008;25(5):E10.
- Benger J, Blackham J. Why do we put cervical collars on conscious trauma patients? Scand J Trauma Resusc Emerg Med 2009;17:44.
- Greaves I, Porter K, Garner J. Trauma Care Manual. 2nd edn. Hodder and Arnold, 2009. Chapter 12.
- Slack SE, Clancy MJ. Clearing the cervical spine of paediatric trauma patients. Emerg Med J 2004;21:189-193.
- Hoffman JR, Mower WR, Wolfson AB et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. N Engl J Med 2001;343:94-9.
- Stiell IG, Wells GA, Vandemheen KL et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA 2001;286(15):1841-8.
- Dickinson G, Stiell IG, Schull M et al. Retrospective application of the NEXUS low-risk criteria for cervical spine radiography in Canadian emergency departments. Ann Emerg Med 2004;43(4):507-14.
- Stiell IG, Clement CM, McKnight RD et al. The Canadian C-Spine Rule versus the NEXUS Low-Risk Criteria in Patients with Trauma. N Engl J Med 2003;349:2510-2518.
- Viccellio P, Simon H, Pressman BD et al. A Prospective Multicenter Study of Cervical Spine Injury in Children. Pediatrics 2001;108:e20-20.
- Ehrlich PF, Wee C, Drongowski R et al. Canadian C-spine Rule and the National Emergency X-Radiography Utilization Low-Risk Criteria for C-spine radiography in young trauma patients. Journal of Pediatric Surgery 2009;44(5):987-691.
- Blackham J, Benger J. Clearing the cervical spine in conscious trauma patients. Trauma 2009;11(2):93-109.
- Swischuk LE, John SD, Hendrick EP. Is the open-mouth odontoid view necessary in children under 5 years? Pediatric Radiology 2000;30:186-189.
- Pollack CV Jr, Hendey GW, Martin DR et al. Use of flexion-extension radiographs of the cervical spine in blunt trauma. Annals of Emergency Medicine 2001;38(1):8-11.
- Marion DW, Domeier R, Dunham CM et al. Practice management guidelines for identifying cervical spine injuries following trauma Update EAST Practice Parameter Workgroup for Cervical Spine Clearance 2001.
- Ptak T, Kihiczak D, Lawrason JN et al. Screening for cervical spine trauma with helical CT: Experience with 676 cases. Emergency Radiology 2001;8(6):315-9.
- Benzel EC, Hart BL, Ball PA et al. Magnetic resonance imaging for the evaluation of patients with occult cervical spine injury. Journal of Neurosurgery 1996;85(5):824-9.
- Como JJ, Diaz JJ, Dunham CM et al. Practice management guidelines for identification of cervical spine injuries following trauma – update from the Eastern Association for the Surgery of Trauma Practice Management Guidelines Committee 2009.
- Davis JW, Kaups KL, Cunningham MA et al. Routine evaluation of the cervical spine in head-injured patients with dynamic fluroscopy: a reapprasial. Journal of Trauma-Injury Infection & Critical Care 2001;50(6):1044-1047.
- Verhagen AP, Scholtne-Peeters G GGM, Van Wijngaarden S et al. Conservative Treatments of whiplash. Cochrane Database of Systematic Reviews, Issue 4, 2009.
- Ct P, Cassidy JD, Carroll L et al. A Systematic Review of the Prognosis of Acute Whiplash and a New Conceptual Framework to Synthesize the Literature. Spine 2001;26(19):E445-E458.
- NICE, Spinal injury: assessment and initial management; [Guideline: NG41]. Published: 17 February 2016.
- Bandiera G, Stiell IG, Wells GA et al. The Canadian C-spine rule performs better than unstructured physician judgment. Ann Emerg Med 2003;42(3):395-402.
- Rezaie S, Spinal Immobilization in Trauma Patients; Contemporary research links for immobilisation. REBELEM, 2017.