Ver el código de «Cervical spine clearance»

==Background==
*US and Canada with more than 13 million trauma pts per year at risk for C-spine injury
*Most blunt trauma patients will be placed in a cervical collar by EMS to protect the C-spine
*C-spine can be clinically cleared by trained personnel

==Clinical Features==
C-spine injuries may present with
* rarely neurogenic shock (bradycardia, hypotension)
* posterior neck pain
* pain on palpation of spinous processes
* limited neck ROM with pain
* weakness, numbness, or paresthesias

==Decision Rules==

{{Template:C-spine NEXUS}}

{{Template:C-spine Canadian}}

== Canadian rule vs. Nexus  ==
A single trial showed Canadian rule would pick up 312 or 313 clinically important cases, while NEXUS would miss 1 one in 10 cases<ref>Stiell IG, Clement CM, and McKnight DR, et al. The Canadian c-spine rule versus the NEXUS low-risk criteria in patients with trauma. NEJM. 2003; 349:2510-2518.</ref>

===Sensitivity===
Canadian 99.4% vs Nexus 90.7% 

===Specificity===
Canadian 45.1% vs. Nexus 36.8%

==Workup==
* if unable to be cleared by NEXUS or Canadian C-spine Rules then imaging is indicated
* CT C-spine noncon or X-rays with odontoid view 
** CT better than Xray <ref> Bailitz J, Starr F, Beecroft M, et al. CT should replace three view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66:1605e1609. </ref>
* Xrays/CTs not adequate to assess for ligamentous instability
* if pt continues to have midline pain after adequate pain control obtain MRI (can be done outpatient)
**keep C-collar until MRI results or pain resolves

==Management==

==Disposition==
*based on imaging results

==See Also==
*[[Blunt neck trauma]]

==External Links==

==References==
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