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Excluding a cervical spinal injury requires clinical judgement and training. Under the NEXUS guidelines, when an acute blunt force injury is present, a cervical spine is deemed to not need radiological imaging if all the following criteria are met: There is no posterior midline cervical tenderness; There is no evidence of intoxication
Finally, the use of magnetic resonance imaging (MRI) allowed for even better depiction of the spine and soft tissue abnormalities in particular. Again, a novel acronym was proposed to classify patients without traumatic signs using radiographs, CT and MRI. The term spinal cord injury without neuroimaging abnormality (SCIWONA) was used.
There are two main algorithms, the Canadian C-spine rule and NEXUS, which are used to decide who requires cervical spine imaging via CT scan [6] after blunt trauma, and who can be cleared without imaging. [4] The Canadian C-spine rule appears to have greater sensitivity and specificity (i.e. fewer false positives and false negatives). [17]
Imaging of the spine to determine the presence of a SCI may need to wait if emergency surgery is needed to stabilize other life-threatening injuries. [102] Acute SCI merits treatment in an intensive care unit, especially injuries to the cervical spinal cord. [101]
Identify the level of the spinal cord where myelopathy is located. This is especially useful in cases where more than two lesions may be responsible for the clinical symptoms and signs, such as in patients with two or more cervical disc hernias [11] Follow-up the progression of myelopathy in time, for example before and after cervical spine surgery
This practice has come under review recently as incidence rates of unstable spinal trauma can be as low as 2% in immobilized patients. In clearing the cervical spine, Canadian studies have developed the Canadian C-Spine Rule (CCR) for physicians to decide who should receive radiological imaging. [9]
The spine (that is, the vertebral column. A projectional radiograph of the spine confers an effective dose of approximately 1.5 mSv, comparable to a background radiation equivalent time of 6 months. Cervical spine: The standard projections in the UK AP and Lateral. Peg projection with trauma only.
The diagnosis is usually suspected by history and physical exam, but confirmed by imaging, typically by CT due to its faster speed in the acute trauma setting, although MRI can also help with assessment in equivocal cases. The treatment is initial stabilization with a cervical spine collar, and then surgical intervention in cases in which ...