The canadian C-spine rule and competitors

You cannot always rely on a trauma surgeon to clear the cervical spine of your epilepsy patient that wears the infamous collar. Having worked as a paramedic here for about 20 years, I concede that the c-collar is way easier to install than to get rid off.

  • If you have a coherent (e.g., non-neurological :-)) patient, you can use the canadian c-spine rule, which requires you first to consider clear high-risk signals (age > 65, dangerous mechanisms, paresthesias), then find a good reason not to image your patient (a so-called low-risk factor).
  • For our average patient (stroky, somnolent, febrile, confused, nursing home resident), you still have to get an image of the cervical spine, if the trauma is only slightly relevant.

Reading uptodate’s article on cervical spine injuries and this review of 2009, I was surprised to learn that MRI really doesn’t add to the management of simple cervical spine injury (which means that ligament trauma doesn’t change the treatment). What I still don’t understand is how plain 3-view-films of the cervical spine is really worse than CT (of course CT is what we do).


One thought on “The canadian C-spine rule and competitors

  1. this is a hugely controversial issue in the emergency medicine world, ranging from – all pts with neck pain even with normal plain films and CT should get an MR to plain films are near perfect IF APPROPRIATELY USED (ie not used in unconscious pts with severe head trauma.)

    So don’t feel bad about being confused – we all are!

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