There I was reading “Accident and Emergency Radiology” by Harvey and finding out how to interpret a cervical spine xrays when I discovered that the NICE guidelines on CT Imaging in Head Trauma had completely changed. For starters, it seems to imply that if anyone is good enough for the CT Head following traumatic brain injury, then they are also good enough for a cervical spine CT.

Who gets a cervical spine CT?

• GCS < 13 on initial assessment.
• The patient has been intubated.
• Xrays are abnormal, unclear or inadequate – this could mean that the swimmer’s view will become a thing of the past, as it was done for making C7/T1 junctions more apparent when not well visualised. Now it seems you move straight to CT cervical spine.
• A definitive diagnosis of cervical spine injury is needed urgently (for example, before surgery).
• The patient is having other body areas scanned for head injury or multi-region trauma – ? all patients getting a CT Head for head injury

Also, if the patient is alert and stable, there is clinical suspicion of cervical spine injury and any of the following apply:

1. age 65 years or older
2. dangerous mechanism of injury (fall from a height of greater than 1 metre or 5 stairs; axial load to the head, for example, diving; high-speed motor vehicle collision; rollover motor accident; ejection from a motor vehicle; accident involving motorised recreational vehicles; bicycle collision)
3. focal peripheral neurological deficit (including paraesthesia in the upper or lower limbs).

Those last three seem lifted straight from the Canadian C Spine rule.

Who can be cleared clinically?

People who don’t meet CT cervical spine criteria AND have at least one of the following:

1. was involved in a simple rear-end motor vehicle collision
2. is comfortable in a sitting position in the emergency department
3. has been ambulatory at any time since injury
4. has no midline cervical spine tenderness
5. presents with delayed onset of neck pain.

According to NICE, if they can then actively rotate their neck 45 degrees to the left and right, that clears the C-spine.

What is the role of cervical xrays?

Those who don’t meet CT cervical spine criteria AND cannot be cleared clinically (either failing to be cleared clinically, or not having one of the 5 factors above that permit attempting to clear the c-spine clinically) should have 3 view C=spine xrays.

What’s this all based on?

It closely follows the Canadian C Spine rules: