A C-spine injury refers to any injury that affects the cervical portion of the spinal column

Aetiology

• C-spine injuries typically result from high-energy trauma
• Major risk factors include:
  • Motor vehicle collisions
  • Falls from height
  • Diving accidents
  • Sports-related injuries, particularly contact sports and high-velocity sports
  • Direct impact to the head or neck
  • Acts of violence such as gunshot wounds or stabbings

Clinical features

Patients with C-spine injury can present with a wide array of symptoms, including:

• Neck pain
• Decreased range of motion in the neck
• Focal neurological deficits, such as weakness or numbness in the arms or legs
• Signs of spinal shock, including flaccid paralysis and loss of bowel or bladder control

Investigations

• Detailed history and examination: this can reveal important information about the mechanism of injury, onset and location of symptoms
• The NEXUS criteria: useful for identifying patients at low risk of C-spine injury
• Imaging: when doubt exists or when NEXUS criteria are not met, imaging (preferably CT C-spine) should be done

Nexus criteria

• NEXUS criteria can also be used to identify patients at low risk of C-Spine injury
• C-Spine injury is unlikely if all of the following criteria are met:
  • Normal level of alertness
  • No evidence of intoxication
  • No painful distracting injuries
  • No focal neurological deficit
  • Absence of midline cervical tenderness
• If all of the above criteria are met, the C-Spine may be 'cleared' and imaging may not be required
• If C-Spine cannot be cleared clinically, or there is any doubt, proceed with imaging (CT C-Spine, plain x-rays of limited value and not recommended)

Management