According to the NEXUScriteria, a patient undergoing trauma who meets all of the following criteria can have their c spine cleared clinically without imaging:

Cervical spine clearance must be attended by senior clinical medical staff, after review and reporting of the appropriate cervical spine imaging and must clearly documented in the health care record. Documentation includes: the injury description, level of injury, management plan and spinal mobility and restrictions.

The goal is to clear the C-spine within four hours. If there is a significant painful “distracting” injury, then the goal is to clear the C-spine in less than 12 hours. iii. If the CT shows abnormalities, then the orthopedic or neurosurgical spine service should be consulted prior to removing the collar.

No decision‐making tool has yet been validated for the clearance of c‐spine after injury in prehospital care. Such tools have, however, been validated in the hospital environment with some evidence to support clearance of c‐spine by nurses in the ED.

“We conditionally recommend cervical collar removal after negative high-quality c-spine CT scan results alone.” They went on to further clarify, “It should be acknowledged that cervical collar removal can result in neurological change and even paralysis, although this may be underreported in the literature.

1. No midline tenderness.
2. No pain with neck movement.
3. No distracting injury.
4. No neuro deficit.
5. No alcohol or drugs.
6. No altered mental status.

In addition to “neck” or “C-spine precautions”, all trauma patients are cared for with thoracic and lumbar level protection. This is sometimes collectively called “C-T-L” precautions. Patients with spinal precautions are turned very carefully to prevent flexion or movement of the vertebrae.

The collar is usually worn for a period of twelve weeks to support your neck and prevent movement around the injury site but this can alter depending on your healing rate and your consultant’s opinion.

Stabilizing the cervical spine To prevent hyperextension of the head and neck, padding between the occiput and the board must be used in the vast majority of patients who are immobilized. Remember to immobilize the torso first, followed by the head and neck.

1. Provide reassurance and analgesia.
2. Whilst minimising neck movement, gently palpate the posterior midline of the neck.
3. Repeat the process lateral to the midline on both sides.
4. Tenderness may indicate vertebral or soft tissue injury.

The CCR is only intended for use with alert and stable trauma patients with neck pain; therefore, patients over the age of 65 with neck pain do not necessarily require imaging.

Definition. Brown-Sequard syndrome (BSS) is a rare neurological condition characterized by a lesion in the spinal cord which results in weakness or paralysis (hemiparaplegia) on one side of the body and a loss of sensation (hemianesthesia) on the opposite side.

DEFINITION: C-Spine: Includes C1 to the upper border of T1. Clearance of C-Spine: A clinical decision suggesting the absence of acute bone related, ligamentous and neurologic abnormalities of the cervical spine based on history, physical exam and/or negative radiologic studies.

The exam should be documented and cervical collar may be removed. 1 Normal mental status 2 No alteration in level of alertness 3 No age or developmental concerns 4 Normal neurologic exam 5 Absence of tenderness to cervical spine/soft tissue palpation 6 Absence of pain with active range of motion of the neck 7 Absence of distracting injuries

C-spine clearance with CT was highly accurate and reliable for identifying clinically significant spine injuries, and had a 100% NPV for identifying unstable injuries. ↑ 27. Hoffman JR, et al. Low-risk criteria for cervical-spine radiography in blunt trauma: a prospective study.

Clinicians evaluating the cervical spine for injury should take patient age into account when deciding whether to order cervical spine imaging. In some patients, clinical examination alone cannot rule out CSI.