BMJ Best Practice Podcast Cervical spine injury
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Jan 23, 2024 Learn about cervical spine injuries, their diagnosis, and management in this podcast. Mich, an expert in the field, discusses the importance of accurate diagnosis, the use of cervical collars, and the role of neurological assessment. The podcast also highlights the challenges in diagnosing these injuries and the management of cervical spinal cord injuries in older individuals with medical comorbidities.
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Definition And Initial Assessment
- Cervical spine trauma includes blunt and penetrating injuries from collisions, sports, diving, falls, or violence.
- Assessment must combine mechanism, demographics, symptoms, and a focused neurologic and neck exam.
Use ASIA Scale And Be Cautious With Collars
- Use the ASIA/INSCI neurological exam with key myotomes and dermatomes to grade spinal cord injury and document level.
- Preserve cervical collars until imaging if high-velocity injury or neurologic signs exist, and remove carefully when safe.
Prefer CT First; MRI For Cord Or Ligament Injury
- Obtain thin-slice CT from skull base to upper thoracic spine as first-line imaging for suspected cervical injury.
- Get MRI when neurologic complaints, radiculopathy, or suspected ligamentous/cord injury (e.g., SCIWORA, central cord syndrome).