Clearing Cervical Spine

Question 1

C spine clearance can be determined by what?

Answer 1

• Physical exam
• Radiolographically- plain films/CT

Question 2

What from the hx would give you concern over a C spine injury?

Answer 2

• Energy of injury
  
  • RTA >35mph
  • Fall >10 feet
  • closed head injury
  • neurological
  • pelvis and extremity fx
• Mechanism of accident
  
  • elderly pt hit forehead- hyperextension
  • pt rear eneded- hyperextension
• Condition of pt at scene of accident
  
  • degree of conscious level
  • neurological deficits
• Associated conditions
• Ankylosing spondylitis
• diffuse idipathic skeletal hyperextosis- DISH
• previous c spine fusion
• connective tissue disorder-> ligamentous laxity

Question 3

What is your physical exam of pt with c spine injury?

Answer 3

ATLS exluding an lifethreatening injuries

Primary survey

• AIRWAY & C SPINE IMMMOBILISATION
• BREATHING
• CIRCULATION
• visual and manual inspectionof whole spine
• selt belt sign= fexion distraction injury of thoracolumbar spine

secondary survery

• C spine exam
• remove immobilisation collar
• examine face/scalp
• rotational deformities of neck- unifacet dislocation
• palpation post cervical spine- tenderness midline/parapinal
• absence of midine tenderness in an awake, alert pt predicts low probability of sig cervical injury
• log roll- inspect and palpate
• neuro exam

Question 4

How would you clinical clear cervical spine?

Answer 4

• Removal har collar without radiological studies if
• pt awake, alert and not intoxicated and
• has no neck pain, tenderness, or neurological deficit and
• has no distracting injuries

Question 5

What are the indications for obtaining radiographic clearance?

Answer 5

• intoxicated pt
• pt with altered memory state- dementia
• neck pain or tenderness present or
• distracting injury

Question 6

What must the radiograph have to clear a neck?

Answer 6

• Adequate top of C1 to C7/T1 junction
• must include AP, LAT and open mouth
• assess alignment by 4 parallel lines
• look for sutble
  
  • soft tissue swelling
  • hyperlordosis
  • disk space narrowing/widening
  • widening of interspinous distances

MRI

• HIghly sensitive for detection of soft tissue injuries
• disc herniation
• post ligament injuries
• spinal cord changes

Question 7

What are the complications of c spine clearance?

Answer 7

• delayed clearance
  
  • Increased risk of aspiration
  • inhibition of respiratory function
  • decubitius ulcers in occiptal and submandibular area
  • possible increase in intracranial pressure