General information
- In the age group ≤ 9 yrs, 67% of cervical spine injuries occur in the upper 3 segments of the cervical spine (occiput-C2).
Evaluation
NICE criteria C spine
- Note: If the person is unable to understand commands or open their mouth, a peg view may be omitted.
- predisposing condition: collagen vascular disease, osteogenesis imperfecta, axial spondyloarthritis
Age Group | 16 and over | |
16 and over | HI + any High-risk factors: • GCS ≤ 12 • Intubated • Urgent diagnosis needed (spinal manipulation) • Blunt polytrauma • Clinical suspicion of C spine injury + any of the following ◦ >65 ◦ Dangerous mech ◦ Neuro deficit (motor/sensory) HI + Neck pain/tenderness + no high risk features • Not safe to assess neck ROM • Neck ROM < 45 degree rotation • predisposing condition-higher risk of injury to the cervical spine | CT Cervical Spine Scan Within 1 hour |
Under 16 | High-risk factors: • GCS ≤ 12, • intubated, • Neuro deficit (motor/sensory)urgent diagnosis needed, • clinical suspicion with other scans, • strong suspicion despite normal X-rays, • difficult/inadequate X-rays, • significant bony injury | CT Cervical Spine Scan Within 1 hour |
Under 16 | Head injury + neck pain/tenderness + no CT indications • Dangerous mechanism of injury • Not safe to assess neck ROM • Neck ROM < 45 degree rotation • predisposing condition-higher risk of injury to the cervical spine | 3-View Cervical Spine X-Rays Within 1 hour |
Nexus criteria (National Emergency X Radiography Utilization Study)
Criteria | Explanations |
1. No posterior midline cervical tenderness | Midline posterior bony cervical spine tenderness is present if the patient complains of pain on palpation of the posterior midline neck from the nuchal ridge to the prominence of the first thoracic vertebra, or if the patient reports pain with direct palpation of any cervical spinous process. |
2. No evidence of intoxication | Patients should be considered intoxicated if they have either of the following: (a) a recent history, by the patient or an observed intoxication or intoxicating ingestion; or (b) evidence of intoxication on physical examination, such as odour of alcohol, slurred speech, ataxia, dysmetria, or other cerebellar findings, or any behavior consistent with intoxication. Patients may also be considered to be intoxicated if tests of bodily secretions are positive for drugs that affect level of alertness, including a blood alcohol level greater than 0.08 mg/dL. |
3. Normal level of alertness | An altered level of alertness can include any of the following: (a) Glasgow Coma Scale score of 14 or less; (b) disorientation to person, place, time, or events; (c) inability to remember 3 objects at 5 minutes; (d) delayed or inappropriate response to external stimuli; or (e) other. |
4. No focal neurological deficit | Any focal neurological complaint (by history) or finding (on motor or sensory examination). |
5. No painful distracting injuries | No precise definition for distracting painful injury is possible. This includes any condition thought by the clinician to be producing pain sufficient to distract the patient from a second (neck) injury. Examples may include, but are not limited to, the following: (a) a long bone fracture; (b) a visceral injury requiring surgical consultation; (c) a large laceration, degloving injury, or crush injury; (d) large burns; or (e) any other injury producing acute functional impairment. Physicians may also classify any injury as distracting if it is thought to have the potential to impair the patient’s ability to appreciate other injuries. |
ㅤ | *If all of these criteria are met, imaging is not required in order to exclude clinically important CSI. |
- Retroclival hematoma
- on imaging should prompt immobilization and evaluation for atlantooccipital dislocation (AOD).
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