Injury to the lower cervical nerves and/or the spinal cord may result in paralysis of both the upper and lower extremities (arms and legs) and can lead to bowel and bladder dysfunction. Adolescents and young adults between the ages of 16-24 have the highest incidence of spinal injuries. Cervical spine injuries occur due to deformation of the cervical spinal column, which may lead to spinal cord damage. Injuries at or above the C5 vertebrae can be particularly severe, potentially inhibiting ventilation controlled by the central nervous system.
Guidelines for cervical spine clearance were established to provide safe and prompt assessment for pediatric trauma patients who are at high risk for cervical spine injuries. The term “C-Spine” encompasses the region from C1 to the upper border of T1. Clearance of the C-Spine is a clinical decision based on a comprehensive evaluation including history, physical examination, and potentially negative radiologic findings, indicating no acute bone-related, ligamentous, or neurologic abnormalities.
Injuries to the C1 atlas, the uppermost cervical vertebra, can have significant implications as it supports the head and, along with the C2 axis, enables head movement. Children’s bones, including those of the C1 atlas, are softer at birth, which can affect the injury pattern. The higher the injury on the spinal column, the more severe the potential consequences.
Only an attending physician or senior resident should clinically clear the C-Spine, which must be documented appropriately. The data on clearance in obtunded patients with negative cervical spine CT scans remains a topic of debate. However, a systematic review conducted by the Eastern Association for the Surgery of Trauma (EAST) in 2015 showed a 100% negative predictive value of CT scans for unstable cervical spine injuries in this group.
For further detailed information on lower cervical spine injuries, guidelines for cervical spine clearance, and treatment protocols, visit the Children’s Hospital of Philadelphia, UConn’s Korey Stringer Institute, the University of Texas Health Science Center, Upstate Medical University, Stanford Medicine, and the American Medical Center’s resources.
Lower Cervical Spine Injuries C3-C7
Cervical Spine Injury
Guideline for Cervical Spine Clearance
Cervical Spine Clearance
Stanford Trauma Guidelines
C1 Atlas Spine Injury
Trauma-Related Spine Conditions
Cervical Spine Clearance Trauma Practice Management Guideline
C-Spine Precautions Updates
