Cervical Spine Clearance

Cervical Spine Clearance; Canadian C Spine Rule vs. Nexus I Study

C Spine clearance provide standard early protection for trauma patient as 2–6% of admitted trauma patient suffered from blunt trauma to the cervical spine. 5-10% of pt shows deterioration of neurological function during ED admission d/t delay in diagnosis@ inadequate spinal admission

Two commonly use criteria to establish which patient needs cervical clearance are Nexus I study and Canadian C- Spine Rule.

High risk patient require radiological clearance according to Nexus can be remembered by mnemonics “NSAID”

N- Neurological deficit

S- Spine (cervical) tenderness

A- Altered mental status

I- Intoxication

D- Distracting pain

Meanwhile, according to Canadian C Spine Rule, we can divide patient into high risk criteria requiring imaging and low risk patient which can be allowed to undergone assesment of active range of motion.

High risk patient requiring imaging

1) Age more than 65 years

2) Dangerous mechanism of injury (fall from 1m @ 5 stairs); axial load to the head (eg; diving); MVA at high speed (more than 100 km/hr), rollover, ejection; motorized recreational vehicles; bicycle collision

3) Paraesthesia in extremities

Low risk patient to undergone assessment of active range of motion.

1) Simple rear end motor vehicle collision (excluding of being pushed into oncoming traffic, being hit by bus or large truck, rollover, hit by high speed vehicle)

2) Sitting position in the emergency department

3) Ambulatory at any time

4) Delayed onset of neck pain

5) Absence of midline C-spine tenderness

Method of cervical clearance

1) Cervical X ray 3 view series (lateral view skull base up to C7/T1 junction, AP view, Open mouth odontoid)

2) CT scan is more superior to 3 view series X-ray in high risk patient

3) As a general rule, CT scan cervical clearance is indicated in unconscious patient.

4) MRI is the best modality for soft tissue injury.