DIAGNOSIS
■ The decision to image the C-spine is based on the mechanism of injury,
pain, tenderness, neurologic findings, and the alertness of the patient.
■ TheNational Emergency X-Radiography Utilization Study (NEXUS)
has identified five criteria that have 99.6% sensitivity of detecting clinically
significant C-spine injury.
■ According to NEXUS, spinal imaging is not required if patient has all of
the following:
■ No posterior midline cervical spine tenderness
■ No focal neurologic deficits
■ No evidence of intoxication
■ Normal level of alertness
■ No painful distracting injuries
■ A C-spine series consists of AP, lateral, swimmer’s, and odontoid views.
Obliques may be included.
■ Up to 80% of C-spine injuries can be detected by the lateral C-spine film.
■ The C7-T1 junction must be included as 20% of injuries occur at C7.
■ Swelling of the prevertebral soft tissue suggests injury; a measurement
> 7 mm at C2 and 21 mm at C6 are abnormal.
■ On a lateral C-spine X-ray, three imaginary lines are identified (see
Figure 3.4). Disruption to any line suggests injury.
■ Anterior contour line: Formed by anterior margin of vertebral body
■ Posterior contour line: Formed by posterior margin of vertebral body
■ Spinolaminar line: Connects the bases of the spinous processes and
extends to the posterior aspect of the foramen magnumTRAUMA
Although posterior neck
tenderness is one of the
NEXUS criteria, posterior neck
pain is not.The NEXUS criteria can be
divided into two groups:- Criteria suggesting injury:
Tenderness, neurologic
deficit. - Criteria that impede exam:
AMS, intoxication,
distracting injury.
FIGURE 3.4. Diagram of lines on lateral C-spine.(Reproduced, with permission, from Tintinalli JE, Kelen GD, Stapczynski JS.Emergency
Medicine:A Comprehensive Study Guide, 6th ed. New York: McGraw-Hill, 2004:1703.)