C-spines must be cleared radiographically and clinically. Therefore patient with possible C-spine injury should be left in precautions until they are awake and alert for a clinical assessment.
Canadian C-spine Rule
Patient must be alert and stable – but complain of neck pain. The rule was designed to identify patients who are unlikely to suffer significant C-spine fractures. Those who fit the rule will receive C-spine X rays.
High risk factors (if yes X ray):
- ≥65 years old
- Dangerous mechanism
- Fall from ≥ 3 feet or 5 stairs
- High speed (roll over, ejection, ≥ 100kph)
- Motorized recreational vehicle (ATV, snowmobile)
- Bicycle collision
- Axial load (diving)
- Paresthesias in extremities
Low risk factors that allow safe assessment of ROM (if no X ray):
- Simple rear-end motor vehicle collision
- Excludes pushed into oncoming traffic, rollover, hit by large vehicle, hit by high speed vehicle
- Sitting position in ED
- Ambulatory at any time
- Delayed onset of neck pain
- Absence of midline C-spine tenderness
If deemed safe to assess ROM, and unable to rotate neck 450 to each side must X ray.
Imaging
- X ray views
- Lateral (from occiput to T1) – may need a swimmers view to assess down to T1
- Mandatory in all trauma
- AP (not super useful)
- Odontoid view (open mouth)
- Lateral (from occiput to T1) – may need a swimmers view to assess down to T1
- Assessment of the lateral view
- Alignment
- Ant vertebral body line
- Post vertebral body line
- Spinolaminar line
- Spinous processe
- Bone contour
- Cartilage: check intervetebral disc space margins (should be parallel)
- Soft tissue
- <6mm @ C2; <22mm @ C6 <7mm @ C3; <21mm @ C7