C spine clearance

Clinical clearance

• 2 rules to remember: Nexus and canadian c-spine rule

• NEXUS:– Focal neurological deficit– Midline spinal tenderness– ALOC– Intoxication– Distracting injury

What is a distracting injury?

• Original study: Not explicitly stated• Other suggestions: Long bone fracture,

intra-abdominal injury, degloving injury, large laceration, intracranial injury.

• Chest injury may be more distracting• Injuries may not be distracting at all• Are they distracted by pain or ALOC

because of analgesia?

Canadian C spine rule

Ages

• Caution over 65• Use NEXUS for children• Caution under 8

Imaging

• Sensitivity of plain films is ~85%• Sensitivity of CT >95%• Plain films no good if you have big

shoulders

What I do

• Age >65: CT• Age 45-65: Probably CT unless very low

risk, in which case why image them• Age <45 Start with plain films unless high

suspicion of injury• Young, football player, low suspicion of

injury: Go to xray, pull on patient’s arms

How to interpret a C-spine film

• Plain films only! wait on the report for a CT• Check film adequacy

– All vertebrae covered from skull to T1

•Alignment: Anterior line, posterior line and spinolaminar line•Bones: look through all vertebrae for breaks in cortex

Lateral view

•Disc spaces – should be approximately equal in height•Soft tissues: 7mm wide at C2, 2cm wide at C7•Or <1/3 vertebral body above C4 and <100% below C4

Check alignment – Lateral edges and spinous processesSpacing – spinous processes should be line up and spaced evenly

AP view

Adequate if shows the alignment of lateral masses on both sidesDistance between the peg and lateral masses should be equal

Peg View

Swimmers view

• Get a CT.