Cervical Hyperextension Flashcards
What are the key components of evaluating an adult patient with neck pain?
History, physical exam, neurological assessment, imaging if indicated
Which imaging modality is first-line for evaluating cervical spine injuries in adults?
CT C-spine without IV contrast
What are the NEXUS criteria used for?
To determine if cervical spine imaging is necessary after blunt trauma
List the five NEXUS criteria.
No posterior midline cervical tenderness, No focal neurological deficit, Normal alertness, No intoxication, No distracting injury
What is the Canadian C-Spine Rule (CCSR)?
A clinical decision rule used to determine the need for cervical spine imaging following blunt trauma
What are the three high-risk features in the Canadian C-Spine Rule?
Age ≥ 65, Limb paresthesias, Dangerous mechanism of injury
Which patients require immediate cervical spine imaging?
Those with high-risk CCSR features, NEXUS criteria positive, or neurological deficits
What are the common symptoms of cervical hyperextension injury?
Neck pain, muscle spasm, limited range of motion, potential neurological deficits
What neurological symptoms may be seen in a severe cervical hyperextension injury?
Weakness, paresthesia, loss of reflexes, spinal cord compression signs
What is the best imaging modality for assessing ligamentous or spinal cord injuries?
MRI C-spine without contrast
What are common causes of cervical hyperextension injuries?
Whiplash, rear-end motor vehicle collisions, falls, sports injuries
What is the role of X-rays in adult cervical spine evaluation?
Not routinely recommended; lower sensitivity than CT
What is the clinical significance of a ‘dangerous mechanism’ in the Canadian C-Spine Rule?
Indicates higher risk of serious cervical injury (e.g., high-speed MVC, axial load, fall from >1 meter)
What is the predental space, and what is considered abnormal?
The space between the odontoid process and the anterior arch of C1; >3mm in adults and >5mm in children is abnormal
What spinal immobilization techniques are used in suspected cervical spine injury?
Rigid cervical collar, manual in-line stabilization, log-roll maneuver
What are potential complications of prolonged cervical spine immobilization?
Pressure ulcers, aspiration, elevated ICP, ventilator-associated pneumonia
When should a cervical collar be removed in a patient with suspected injury?
After clinical and/or radiographic clearance to prevent complications
What are the signs of a spinal cord injury in cervical trauma?
Loss of sensation, motor weakness, reflex changes, bladder/bowel dysfunction
What should be done if a patient with suspected cervical spine injury has a neurological deficit?
Urgent MRI and neurosurgical consultation
When is an MRI indicated in cervical spine evaluation?
If neurological deficits, suspected ligamentous injury, or spinal cord compression
What condition can result from cervical hyperextension injury in elderly patients?
Central cord syndrome (characterized by greater weakness in the upper limbs than lower limbs)
What is the purpose of a swimmer’s view X-ray?
To visualize the C7-T1 junction when standard lateral views are inadequate
What clinical features suggest whiplash-associated disorder?
Neck pain, stiffness, headache, dizziness, and soft tissue injury after hyperextension-flexion mechanism
How is whiplash typically managed?
Supportive care: pain management, physical therapy, gradual return to activity
What are red flag symptoms in a patient with neck pain?
Neurological deficits, fever, weight loss, history of cancer, night pain, trauma
Which patients with neck pain require urgent neurosurgical evaluation?
Those with spinal cord compression signs, unstable fractures, or progressive neurological deficits
Which age group should be considered high risk for cervical spine injury even with minor trauma?
Patients ≥ 65 years old
What is the significance of a normal CT C-spine in an obtunded patient?
May still require MRI if ligamentous injury is suspected
