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Acute cervical spine trauma

Last reviewed: 9 Nov 2024
Last updated: 24 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

  • concordant mechanism of injury
  • neck pain
  • sacral sparing
  • associated traumatic injury
  • posterior cervical tenderness
Full details

Other diagnostic factors

  • reduced level of consciousness
  • numbness, tingling, or weakness of extremities
  • motor weakness
  • sensory loss
  • bowel or bladder dysfunction
  • priapism
  • reduced or painful cervical range of motion (ROM)
  • loss of anorectal tone and perianal sensation
  • stroke
  • cranial nerve deficit
  • hyperreflexia
  • Babinski sign
  • Hoffman sign
  • neurogenic shock
  • spinal shock
  • respiratory change
Full details

Risk factors

  • age 18 to 25 or >65 years old
  • a dangerous mechanism of injury
  • distracting traumatic injuries
  • intoxication
  • lack of preparation or awareness of collision
  • head rotated at time of collision
  • previous cervical spine trauma or surgery
  • pre-existing spinal, cranial, or other abnormality
  • stroke
Full details

Diagnostic tests

1st tests to order

  • multidetector computed tomography (MDCT)
Full details

Tests to consider

  • CT whole spine
  • cervical spine x-ray series
  • MRI cervical spine
  • CT myelogram
  • CT angiography (CTA) and MR angiography (MRA)
  • flexion-extension (F/E) cervical spine x-rays
  • nerve conduction studies
  • electromyography
Full details

Treatment algorithm

INITIAL

suspected c-spine injury: at initial presentation

ACUTE

low probability of neurological injury: following initial assessment

high probability of neurological injury: following initial assessment

Contributors

Authors

Michael G. Fehlings, MD, PhD, FRCS(C), FACS
Michael G. Fehlings

Professor

Division of Neurosurgery

Director of Neuroscience Program

University of Toronto

Krembil Chair in Neural Repair and Regeneration

Medical Director

Krembil Neuroscience Center

Toronto Western Hospital

Ontario

Canada

Disclosures

MGF has served as a consultant for Fortuna Fix. MGF is an author of a reference cited in this topic.

Karlo M. Pedro, MD

Clinical Spine Fellow

Division of Neurosurgery

Department of Surgery

University of Toronto

Ontario

Canada

Disclosures

KMP declares that he has no competing interests.

Acknowledgements

Dr Michael G. Fehlings, and Dr Karlo M. Pedro would like to gratefully acknowledge Dr Narihito Nagoshi, Dr Hiroaki Nakashima, Dr David W. Cadotte, Dr Jefferson R. Wilson, Dr Christopher S. Ahuja, and Dr Fan Jiang, previous contributors to this topic.

Disclosures

NN, HN, DWC, JRW, CSA, and FJ declare that they have no competing interests.

Peer reviewers

Jwalant Mehta, MS Orth, D Orth, MCh Orth, FRCS (Tr & Orth)

Consultant Orthopaedic and Spinal Surgeon

BMI Werndale Hospital

Carmarthen

Carmarthenshire

UK

Disclosures

JM has been provided with educational support for attending conferences by Medtronic, Depuy Spine UK, and Nuvasive.

Alpesh Patel, MD

Assistant Professor

Orthopedic Surgery Operations

Department of Orthopedics

University of Utah

Salt Lake City

UT

Disclosures

AP is an author of a reference cited in this topic.

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