Spinal Trauma
As always, what is considered ‘significant’ is contentious. Nevertheless, it is worth noting that 10% of major head injuries will have a concurrent spinal injury - Mike Cadogan
HWN Suggests
Trauma! Spinal Injury
If pain is the only symptom, I generally take into account patient factors (e.g. age) and suspicion based on mechanism. If I have a low degree of suspicion of significant injury I will provide analgesia and re-examine after a period of observation. Often the patient’s symptoms resolve and specific imaging is unnecessary. Avoid using this approach in the presence of distracting injuries or an altered mental state.
Note that significant thoracolumbar spinal injury can be present in the absence of midline tenderness.
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Canadian C-Spine Rule
The CCR is only intended for use with alert and stable trauma patients with neck pain; therefore, patients over the age of 65 with neck pain do not necessarily require imaging.
NEXUS Criteria for C-Spine Imaging
The notion that tenderness is quantifiable on a score without trusting the patient is crazy. Let’s go back and remember what this is about: our goal was never to get rid of negative c-spine films, our goal was to get rid of an extra percentage of those. 98% of them were already negative. We wanted to see if there was a way to avoid doing a film in somebody that everyone in the world knows is okay, and we’re only doing it because we’re all scared.
Articles of Interest
C-Spine Injuries + CT Interpretation
There are many different systems to organize cervical spine injuries. Furthermore, there exist a long listing of possible cervical spine injuries; this is not a complete listing. This post will only cover the most unstable and the most severe injuries.
Emergency Neurological Life Support: Traumatic Spine Injury
Traumatic spine injuries (TSIs) carry significantly high risks of morbidity, mortality, and exorbitant health care costs from associated medical needs following injury.
Evaluation of the Thoracic and Lumbar Spine in Blunt Trauma
Evaluation for injury of the cervical spine following blunt trauma was made much easier by the derivation and subsequent validation of key clinical decision rules (NEXUS criteria, Canadian c-spine rule). Unfortunately, no such rule exists for evaluation of the thoracic and lumbar spine.
Spine Injuries
Patients with stable fractures and no neurologic deficits may be discharged. Recommend Philadelphia or Miami collar to the patients with suspected ligament injury.
