Cervical Spine Injuries: Detecting Clinical Significance

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CRITERIA for Determining Cervical Spine Injuries:

Ruling out a cervical spinal injury requires clinical judgement and training.

C spine Injury - Clayton A. Chan, DDS

Cervical spine is determined to be stable if the following is present:

  • There is no posterior midline cervical tenderness
  • There is no focal neurological deficit (see focal neurological signs)
  • The patient is alert and oriented to person, place, time, and event
  • There is no evidence of intoxication
  • There are no painful distracting injuries (e.g., long bone fracture)

If the patient does not meet the above criteria then they require the following:

  1. A three view cervical x-ray series which includes the C7/T1 interface.
  2. In those with degenerative disease of the cervical spine, a plain film series is often inadequate to assess for injury. Plain radiographs, even when technically optimal, may fail to reveal significant injury.
  3. If there is clinical suspicion, a Computerized Tomography (CT Scan) may be needed to rule out a fracture, and flexion-extension radiographs or Magnetic Resonance Imaging to exclude a ligament injury.

C Spine Rules