C-Spine X-rays

Neck pain post RTC is a common clinical presentation and can form an easy exam question. Anything from interpreting an X-ray to questions on guidelines for choosing who/ how to image could come up.

http://www.radiologymasterclass.co.uk/tutorials/musculoskeletal/x-ray_trauma_spinal/x-ray_c-spine_normal.html - Is a good guide to interpretting C-spine X-rays.

The ABCD approach of ATLS is also an accepted approach.

Imaging (XR) should be performed in the following (CEM recommendations):

• GCS <15
• Neurological deficit/ parasthesia
• Hypotension or abnormal respirations
• Neck pain >7/10
• Patients with neck pain + one of the following high risk factors
• fall >1m / 5 stairs
• axial loading
• RTC >60mph/ rollover/ ejection
• Bicycle collision
• Age >65
• Injury >48 hr previously
• Representation with the same injury
• Known vertebral disease
• Patients with a high risk factor and injury above clavicle/ painful thoracic injury even if no neck pain.

The exceptions being if there are no high risk factors and any of the following low risk factors then an assessment of range of movement can be made...

• Simple rear-end RTC
• Sitting in ED
• Mobile at any time
• Delayed onset of pain
• Absence of midline tenderness

CT When:

• GCS <13
• Intubated
• Inadequate XR or uncertainty
• If CT for head injury or multiregion trauma

CEM Guidline pdf, Practical guide