Summary
Definition
History and exam
Key diagnostic factors
- mecanismo de lesão concordante
- dor cervical
- preservação sacral
- lesão traumática associada
- sensibilidade cervical posterior
Other diagnostic factors
- nível de consciência reduzido
- dormência, parestesia ou fraqueza dos membros
- fraqueza motora
- perda sensitiva
- disfunção do intestino ou da bexiga
- priapismo
- amplitude de movimento (ADM) cervical reduzida ou dolorosa
- perda do tônus anorretal e da sensibilidade perianal
- acidente vascular cerebral (AVC)
- deficit do nervo craniano
- hiper-reflexia
- sinal de Babinski
- sinal de Hoffman
- choque neurogênico
- choque medular
- alteração respiratória
Risk factors
- idade 18 a 25 anos ou >65 anos
- um perigoso mecanismo de lesão
- lesões traumáticas que causam distração
- intoxicação
- falta de preparo ou consciência da colisão
- cabeça rotacionada no momento da colisão
- trauma ou cirurgia da coluna cervical prévios
- anormalidade preexistente na espinha, crânio ou em outra parte do corpo
- acidente vascular cerebral (AVC)
Diagnostic tests
1st tests to order
- tomografia computadorizada com múltiplos detectores (TCMD)
Tests to consider
- TC da coluna vertebral inteira
- série de raios-x da coluna cervical
- ressonância nuclear magnética (RNM) da coluna cervical
- mielografia por tomografia computadorizada (TC)
- Angiotomografia (ATG) e angiografia por RM (ARM)
- radiografias em flexão/extensão (F/E) da coluna cervical
- estudos da condução nervosa
- eletromiografia
Treatment algorithm
suspeita de lesão na coluna cervical: na apresentação inicial
baixa probabilidade de lesão neurológica: após avaliação inicial
alta probabilidade de lesão neurológica: após avaliação inicial
Contributors
Authors
Michael G. Fehlings, MD, PhD, FRCS(C), FACS

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.
References
Key articles
American College of Surgeons. Best practices guidelines: spine injury. Mar 2022 [internet publication].Full text
Fischer PE, Perina DG, Delbridge TR, et al. Spinal motion restriction in the trauma patient - a joint position statement. Prehosp Emerg Care. 2018 Nov-Dec;22(6):659-61.Full text Abstract
American College of Radiology. ACR appropriateness criteria: acute spinal trauma. 2024 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Dor cervical não traumática
- Doença degenerativa da coluna cervical
- Torcicolo adquirido
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