Evaluation and acute management of cervical spinal column injuries in adults
- Amy Kaji, MD, PhD
Amy Kaji, MD, PhD
- Associate Professor of Emergency Medicine
- David Geffen School of Medicine at UCLA
- Robert S Hockberger, MD, FACEP
Robert S Hockberger, MD, FACEP
- Section Editor — Adult Signs and Symptoms
- Emeritus Professor of Medicine
- David Geffen School of Medicine at UCLA
- Section Editor
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editors
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
- Susanna I Lee, MD, PhD
Susanna I Lee, MD, PhD
- Deputy Editor — Radiology
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
This topic review discusses the evaluation and initial management of injuries to the cervical spinal column in adults, including the appropriate use of imaging studies. The importance of early recognition and appropriate management of such injuries is underscored by their association with spinal cord injury.
Descriptions of the range of spinal column fractures and other injuries, the management of spinal cord injuries, and spinal trauma in children are discussed separately. (See "Spinal column injuries in adults: Definitions, mechanisms, and radiographs" and "Acute traumatic spinal cord injury" and "Anatomy and localization of spinal cord disorders" and "Evaluation of cervical spine injuries in children and adolescents" and "Overview of cervical spinal cord and cervical peripheral nerve injuries in the child or adolescent athlete".)
EPIDEMIOLOGY AND ANATOMY
The epidemiology and clinically important anatomy related to cervical spine injuries are discussed separately. (See "Spinal column injuries in adults: Definitions, mechanisms, and radiographs", section on 'Epidemiology' and "Spinal column injuries in adults: Definitions, mechanisms, and radiographs", section on 'Anatomy'.)
MECHANISMS, CLASSIFICATION SCHEMES, AND TYPES OF INJURY
Common mechanisms of injury, classification schemes, and important types of cervical spinal column injuries are discussed separately. (See "Spinal column injuries in adults: Definitions, mechanisms, and radiographs", section on 'Mechanisms of injury' and "Spinal column injuries in adults: Definitions, mechanisms, and radiographs", section on 'Cervical spinal column injury'.)
Prehospital management — General prehospital management of trauma is discussed separately; subjects of particular importance to spinal injury are described below. (See "Prehospital care of the adult trauma patient".)
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- EPIDEMIOLOGY AND ANATOMY
- MECHANISMS, CLASSIFICATION SCHEMES, AND TYPES OF INJURY
- INITIAL MANAGEMENT
- Prehospital management
- - Spinal immobilization
- - Helmet removal
- Emergency department (ED) management
- - Airway management
- - Spinal and neurogenic shock
- - Secondary survey
- Management of spinal cord injury
- RADIOGRAPHIC EVALUATION OF CERVICAL SPINAL COLUMN INJURY
- Overview of imaging
- Imaging of patients not at high risk
- - Clinical decision rules for obtaining radiographs
- Canadian C-spine rule
- NEXUS versus Canadian C-spine rule
- - Plain radiographs versus CT
- - Interpretation of plain radiographs
- Imaging of patients at higher risk
- - CT for cervical spinal column injury
- - MRI for cervical spinal column injury
- Evaluation for ligamentous injury and SCIWORA
- - Epidemiology
- - Approach to imaging
- - Flexion-extension radiographs
- DEFINITIVE MANAGEMENT AND DISPOSITION
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS