C-Spine Trauma

Step 1: Protect the Spine

  • Apply cervical collar

Step 2: Apply NEXUS Criteria

  • Use the “SPINE” mnemonic
    • Spinal midline tenderness
    • Painful distracting injury
    • Intoxication
    • Neurologic deficit
    • Encephalopathy

Step 3: If Patient Has None of the NEXUS Criteria… You Are Done!

Step 4: If Patient Has Positive NEXUS Criteria…

  • Obtain CT scan of the cervical scan without contrast

Step 5: Clear the C-Spine

  • If CT scan negative -> Have patient turn head 45 degrees to right and left
    • If patient has no limitation and no paresthesias or neurologic deficit…
      • Remove collar
    • If still concerned for spinal injury despite normal CT
      • Keep collar on and have patient follow up in clinic for reexam

Unstable Cervical Spine Fractures

  • Mnemonic: Jefferson Bit Off a Hangmans Tit
    • Jefferson fracture
    • Bilateral facet dislocation
    • Odontoid fracture
    • Atlantooccipital dislocation
    • Hangman’s fracture
    • Teardrop fracture

Additional Reading

  • NEXUS Criterial for C-Spine Imaging (MDCalc)
  • Unstable Spine Fractures (WikEM)

1 Comment

  1. Carlos F Crespo , M.D.

    Congratulations for your site. EXCELENT.
    Thank you

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