Mechanism of injury is highly variable, ranging from seemingly innocuous falls to high-energy motor vehicle crashes.
Possible presentations include neck pain, limited range of motion, and/or neurological deficit.
A high index of suspicion and proper investigation is required to detect bone or ligament damage that can otherwise result in spinal cord injury.
If serious injury is suspected, immediate cervical spine stabilization is essential until this is excluded by neurological assessment and computed tomography scan or other imaging.
Maintenance of mean arterial blood pressure and consideration of the use of methylprednisolone are potentially important and time-sensitive therapeutic interventions. The use of methylprednisolone, while certainly time-sensitive, is an intervention whose efficacy is debated among professionals. Early consultation with a specialist is advisable to avoid delays that may affect patient outcome.
This topic concentrates on cervical spine trauma in adults.
Acute cervical spine trauma encompasses a wide range of potential injuries to ligaments, muscles, bones, and spinal cord that follow acute incidents ranging from a seemingly innocuous fall to a high-energy motor vehicle accident. Patients may present immediately after a traumatic incident or days to weeks later. In all cases, careful investigation is required to ensure that the stability of the cervical spine has not been compromised, because, in extreme cases, cervical spine instability can lead to progressive neurological deficit, quadriplegia, and even death.
History and exam
Key diagnostic factors
- concordant mechanism of injury
- neck pain
- sacral sparing
- associated traumatic injury
- posterior cervical tenderness
Other diagnostic factors
- male sex
- age 18 to 25 years
- numbness, tingling, or weakness of extremities
- bowel or bladder dysfunction
- motor weakness
- sensory loss
- reduced or painful cervical range of motion (ROM)
- loss of anorectal tone and perianal sensation
- Babinski sign
- Hoffman sign
- neurogenic shock
- spinal shock
- respiratory change
- cranial nerve deficit
- male sex
- female sex (whiplash injury)
- 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
1st investigations to order
- axial CT cervical spine with 3D reconstructions
Investigations to consider
- 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
acute neck pain with altered neurological status: at initial presentation
low probability of neurological injury: following initial assessment
high probability of neurological injury: following initial assessment
- Nontraumatic neck pain
- Degenerative cervical spine disease
- Acquired torticollis
- Head injury: assessment and early management
- ACR Appropriateness Criteria: Suspected spine trauma
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