C-spine - Introduction

What is required of the staff?
Epidemiology
Rough guide to side of fracture

Trauma care involves the assessment and management of the patient with potential injury to the spine. Emergency centre staff should be experts at managing this potential devastating injury but also be able to clear the C-spine using the NEXUS or Canadian C-spine rule which will be discussed in this chapter. 

What is required of the staff?

1. Understanding of the bio-mechanics of trauma and listening to the handover by EMS. 
2. Focused clinical examination skills 
3. Current knowledge of the indications for spinal radiography, and a sophisticated approach to the interpretation of these x-rays. 
4. A zero-tolerance policy for missed spinal injury will protect patient and physician alike. 
5. NEXUS / Canadian C-spine rule should be placed on the wall in resus and the emergency centre and junior staff should guided by senior clinicians 

Epidemiology 

Spinal cord injury is predominantly a disease of productive young adults. Fifty-five percent of cases occur among people in the 16- to 30-year age group. Overall, 81.7% of patients are male. 

Rough guide to site of fracture

• 65% of vertebral injuries involve the cervical spine, 20% involve the thoracic spine, and 15% involve the lumbar spine. 
• The most common site of fracture in the cervical spine is C2 (including the odontoid), which accounts for roughly 24% of fractures. 
• C3 is the least likely vertebra in the cervical spine to be fractured. 
• Dislocations occur most commonly at C5-C6 or C6-C7 and uncommonly at C7-T1 and the atlanto-occipital complex. 
• Children (<12 years) and the elderly (>50 years) usually sustain injury to the upper cervical spine (C1-C3) 
• approximately 43% of injuries in patients older than 50 years involve the atlanto-axial complex. 
• Young to middle-age adults (12-50 years old) usually sustain injury to the lower spine (C6-T1). 

References: 

1. “Cervical Spine Injury: A State-Of-The-Art Approach to Assessment and Management”. Emergency Medicine Practice, An Evidence-based Approach to Emergency Medicine. http://www.empractice.net. 05/31/04. 

2. Diaz, J. et al. Are Five-View Plain Films of the Cervical Spine Unreliable? A Prospective Evaluation in Blunt Trauma Patients with Altered Mental Status. Journal of Trauma. 2003 Oct;55(4):658-664. 

3. Griffen, M. et al. Radiographic Clearance of Blunt Cervical Spine Injury: Plain Radiograph or Computed Tomography Scan? Journal of Trauma. 2003 Aug;55(2):222-227. 

4. Panacek, E. et al. Test Performance of the Individual NEXUS Low-Risk Clinical Screening Criteria for Cervical Spine Injury. Annals of Emergency Medicine. 2001 July;38(1):22-25. 

5. Hoffman, J. et al. Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma. The New England Journal of Medicine. 2000 July;343(2):94-99.