#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Acute examination to rule out cervical spine injuries in adults


Authors: J. Konečný;  M. Reška;  J. Habr;  R. Hasara;  L. Veverková
Authors‘ workplace: I. chirurgická klinika LF MU a FN u sv. Anny v Brně
Published in: Rozhl. Chir., 2025, roč. 104, č. 7, s. 295-299.
Category: Review
doi: https://doi.org/10.48095/ccrvch2025295

Overview

This paper provides a brief overview of current information and recommendations regard­ing acute imaging of adult patients to rule out cervical spine injuries. It summarizes the possibilities of plain X-ray examination of the cervical spine, which is technically demand­ing and has low diagnostic yield. Therefore, it is no longer recommended. Exceptions are locations where CT is not available and patients for whom exposure to medium or high doses of ionizing radiation is contraindicated. Routinely performed CT examinations of the cervical spine to rule out injury have a significant medical and financial impact. For this reason, internationally recognized criteria sets NEXUS (National Emergency X-Radiography Utilization Study) and CCR (Canadian C-spine Rule) have been introduced. These include information from the patient’s history and clinical examination and are used to indicate the need for cervical spine CT to exclude trauma. Both systems are described and compared. According to some recommendations and in the opinion of the authors, combining the two systems could further improve their effectiveness.

Keywords:

trauma – cervical spine – imaging methods


Sources
1.           Milby AH, Halpern CH, Guo W et al. Prevalence of cervical spinal injury in trauma. Neurosurg Focus 2008; 25(5): E10. doi: 10.3171/FOC.2008.25.11.E10.
2.           Passias PG, Poorman GW, Segreto FA et al. Traumatic fractures of the cervical spine: analysis of changes in incidence, cause, concurrent injuries, and complications among 488,262 patients from 2005 to 2013. World Neurosurg 2018; 110: e427–e437. doi: 10.1016/j.wneu.2017.11.011.
3.           Kumar R, Lim J, Mekary RA et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg 2018; 113: e345–e363. doi: 10.1016/j.wneu.2018.02.033.
4.           American College of Surgeons. Best Practices Guidelines: Spine injury. Chicago: American College of Surgeons Committee on Trauma 2022 [online]. Available from: https://www.facs.org/media/k45gikqv/spine_injury_guidelines.pdf.
5.           British Orthopaedic Association. BOAST – Cervical spine clearance in the trauma patient 2021 [online]. Available from: https://www.boa.ac.uk/resource/boast-cervical-spine-clearance-in-the-trauma-patient.html.
6.           National Institute for Health and Care Excellence. Spinal injury: assessment and initial management. NICE guideline 2016 [online]. Available from: https://www.nice.org.uk/guidance/ng41.
7.           Pimentel L, Diegelmann L. Evaluation and management of acute cervical spine trauma. Emerg Med Clin North Am 2010; 28(4): 719–738. doi: 10.1016/j.emc.2010.07.003.
8.           Davis JW, Phreaner DL, Hoyt DB et al. The etiology of missed cervical spine injuries. J Trauma 1993; 34(3): 342–346. doi: 10.1097/00005373-199303000-00006.
9.           Griffith B, Bolton C, Goyal N et al. Screening cervical spine CT in a level I trauma center: overutilization? AJR Am J Roentgenol 2011; 197(2): 463–467. doi: 10.2214/AJR.10.5731.
10.         Stiell IG, Clement CM, McKnight RD et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med 2003; 349(26): 2510–2518. doi: 10.1056/NEJMoa031375.
11.         Stiell IG, Wells GA, Hoag RH et al. Implementation of the Ottawa Knee Rule for the use of radiography in acute knee injuries. Jama 1997; 278(23): 2075–2079.
12.         Como JJ, Diaz JJ, Dunham CM et al. Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee. J Trauma 2009; 67(3): 651–­659. doi: 10.1097/TA.0b013e3181ae583b.
13.         National Clinical Guideline Centre (UK). Spinal injury: assessment and initial management. London: National Institute for Health and Care Excellence (NICE) 2016.
14.         Laupacis A, Sekar N, Stiell IG. Clinical prediction rules. A review and suggested modifications of methodological standards. Jama 1997; 277(6): 488–494.
15.         Pánková O, Rohan T, Krtička M et al. Rizikové faktory predikující nález fraktury na CT krční páteře u kraniocervikálních traumat – retrospektivní studie. Rozhl Chir 2023; 102(3): 119–124. doi: 10.33699/PIS.2023.102.3.119-124.
16.         Stiell IG, Wells GA, Vandemheen KL et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. Jama 2001; 286(15): 1841–1848. doi: 10.1001/jama.286.15.1841.
17.         Hoffman JR, Wolfson AB, Todd K et al. Selective cervical spine radiography in blunt trauma: methodology of the National Emergency X-Radiography Utilization Study (NEXUS). Ann Emerg Med 1998; 32(4): 461–469. doi: 10.1016/s0196-0644(98)70176-3.
18.         Trauma and Injury Recovery, Sterling M. Clinical guidelines for best practice management of acute and chronic whiplash-associated disorders. Adelaide (Australia): South Australian Centre for Trauma and Injury Recovery (TRACsa) 2008 [online]. Available from: https://implementationcentral.com/doc/Whiplash-Clinical-Guidelines_practitioner.pdf.
19.         de Jager JP, Ahern MJ. Improved evidence-based management of acute musculoskeletal pain: guidelines from the National Health and Medical Research Council are now available. Med J Aust 2004; 181(10): 527–528. doi: 10.5694/j.1326-5377.2004.tb06435.x.
20.         Wootton-Gorges SL, Soares BP, Alazraki AL et al. ACR appropriateness criteria® suspected physical abuse-child. J Am Coll Radiol 2017; 14(5S): S338–S349. doi: 10.1016/j.jacr.2017.01.036.
21.         Ackland H, Cameron P, Cervical spine Assessment following trauma. Aust Fam Physician 2012; 41(4): 196–201.
22.         Hoffman JR, Mower WR, Wolfson AB et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med 2000; 343(2): 94–99. doi: 10.1056/NEJM200007133430203.
23.         British Trauma Society. Guidelines for the initial management and assessment of spinal injury. British Trauma Society, 2002. Injury 2003; 34(6): 405–425. doi: 10.1016/s0020-1383(02)00354-6.
MUDr. Jan Konečný, Ph.D.
I. chirurgická klinika LF MU a FN u sv. Anny v Brně
Pekařská 664/53
602 00 Brno
jan.konecny@fnusa.cz
ORCID autorů
J. Konenčný 0009-0005-5617-4389
R. Hasara 0000-0002-7280-2227
L. Veverková 0000-0001-6578-9274
Labels
Surgery Orthopaedics Trauma surgery
Topics Journals
Login
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account

#ADS_BOTTOM_SCRIPTS#