Cervical Spine Red Flags Flashcards
What is the purpose of the Canadian C-Spine Rules?
To determine whether patients with neck trauma require cervical spine imaging to rule out significant injuries.
What are the three main criteria categories in the Canadian C-Spine Rules?
High-risk factors (mandatory imaging).
Low-risk factors (safe to assess range of motion).
Ability to actively rotate the neck (to assess clearance).
What are the high-risk factors that mandate cervical spine imaging?
Age ≥ 65 years.
Dangerous mechanism of injury (e.g., fall from >1 metre, axial load to the head, motor vehicle collision at high speed).
Paresthesias in the extremities.
What are the low-risk factors that allow safe assessment of neck range of motion?
Simple rear-end motor vehicle collision.
Patient is sitting upright in the emergency department.
Patient is ambulatory at any time after the injury.
Delayed onset of neck pain (not immediate).
Absence of midline cervical spine tenderness.
What is considered a dangerous mechanism of injury?
Fall from a height of over 1 metre or 5 stairs.
Axial load injury (e.g., diving).
High-speed motor vehicle collision (>100 km/h), rollover, or ejection.
Collision involving motorised recreational vehicles.
Bicycle collision.
Which types of rear-end collisions are not considered low-risk?
If the vehicle was pushed into oncoming traffic.
If the collision involved a bus, truck, or rollover.
High-speed collisions.
What is the final step in the Canadian C-Spine Rules after ruling in low-risk factors?
Assess whether the patient can actively rotate their neck:
They must be able to rotate their neck 45 degrees to the left and right.
If unable, imaging is required.
What are red flags in cervical spine assessments, and why are they important?
Red flags are signs or symptoms indicating the potential for serious underlying conditions (e.g., fractures, cancer, infection, or neurological compromise). These require immediate investigation or referral, as physiotherapy alone cannot resolve them.
What systemic conditions are red flags for neck pain?
Cancer: History of malignancy, unexplained weight loss, night sweats, or persistent pain at rest.
Infection: Fever, chills, recent infection, or immune-compromised state.
wVascular: Dizziness, diplopia, or stroke-like symptoms (consider cervical artery dysfunction).
What factors predispose a patient to cervical spine fractures?
Age: Older patients are at higher risk due to reduced bone density.
Osteoporosis: Weakens the bone structure, making low-impact trauma (e.g., a fall or pulling motion) enough to cause fractures.
Prolonged steroid use: Reduces bone strength, often seen in conditions like asthma or rheumatoid arthritis.
History of trauma: Even minor trauma in high-risk individuals may cause fractures.
What is upper cervical instability, and what causes it?
Upper cervical instability refers to excessive movement between the atlas (C1) and axis (C2), leading to potential damage to the spinal cord or brainstem. Causes include:
- Trauma (e.g., whiplash).
- Rheumatoid arthritis (ligament erosion).
- Congenital anomalies (e.g., Down syndrome).
- Long-term steroid use (weakens ligaments and bones).
How should upper cervical instability be assessed and managed?
Assessment: Do not perform manual tests (e.g., sharp-purser) if trauma or high suspicion of instability exists. Radiographs should be done first.
Management:
-Referral for imaging.
-Cervical collar for stability.
-Surgery if instability is dangerous (e.g., fusion).
What is cervical artery dysfunction (CAD)?
CAD is a problem with the blood vessels in your neck. These vessels supply blood to your brain. When they’re not working properly, it can cause serious issues like stroke.
What tests can be used to screen for CAD?
Subjective Screening:
Ask about symptoms like dizziness, headache, or vision changes.
Objective Tests:
- Check blood pressure.
- Feel for pulse in neck arteries.
- Test neck movements to see if they trigger symptoms.
You should be particularly aware of the possibility of CAD, and ask relevant questions, if you or someone you know experiences any of the following:
Sudden onset of:
Severe headache
Dizziness or vertigo
Neck pain or stiffness
Visual disturbances (blurry vision, double vision, temporary blindness)
Difficulty speaking or understanding speech
Weakness or numbness in arms or legs
Sudden falls
