Cervical Spine Injury

Abstract

Vertebral column injury must always be considered in patients with traumatic injuries. The patient should therefore be immobilised on scene. Attend to life-threatening injuries first, minimising the movement of the patient until vertebral fractures or spinal cord injuries have been excluded. Obtain as much information as possible from the patient history and physical examination and as soon as possible in order to establish a baseline in the patient’s neurological status. The examination of awake, alert, sober, neurologically normal and painless patients can be limited to a physical examination only, if there are no positive findings. All other patients should have performed a radiological examination as well; preferably CT imaging of the spine, but if that is not an option, then an AP and lateral view of the cervical spine and first thoracic vertebra, an open-mouth view of the odontoid process and if indicated, also an AP and lateral view of the thoracic and lumbar spine. If the plain x-ray does not rule out the possibility of a spinal injury, transportation to a centre with further examination facilities should be effectuated. Physical examination of the spine includes palpation of the vertebral column (log-rolling the patient), looking for visible lesions, neurological evaluation (motor and sensory deficits including reflexes) and rectal exploration.