Cervical spine injury

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• Cervical fractures and dislocations

📊 NEXUS Criteria Calculator [show]

NEXUS Criteria

NEXUS Criteria for C-Spine Imaging

Criteria (ALL must be absent to clear)	Absent	Present
Posterior midline cervical tenderness	1
Focal neurologic deficit	1
Altered level of alertness	1
Intoxication	1
Distracting painful injury	1
Criteria Present	/ 5

Interpretation
0	C-spine can be cleared clinically — All 5 criteria absent. No imaging needed. Sensitivity 99.6% for clinically significant injury.
≥1	Cannot clear clinically — C-spine imaging indicated.

References
Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma (NEXUS). N Engl J Med. 2000;343(2):94-99. PMID 10891516.

📊 Canadian C-Spine Rule Calculator [show]

Canadian C-Spine Rule

Canadian C-Spine Rule

Step 1: Any High-Risk Factor? (mandates radiography)
Criteria	No	Yes
Age ≥65	1
Dangerous mechanism (fall ≥1m/5 stairs, axial load to head, MVC >100km/h or rollover/ejection, motorized recreational vehicle, bicycle collision)	1
Paresthesias in extremities	1
Step 2: Any Low-Risk Factor? (allows safe ROM assessment)
Simple rear-end MVC (excludes: pushed into traffic, hit by bus/large truck, rollover, hit by high-speed vehicle)	1
Sitting position in ED	1
Ambulatory at any time since injury	1
Delayed onset of neck pain (not immediate)	1
Absence of midline cervical tenderness	1
Step 3: Able to actively rotate neck 45° left and right?
Can rotate neck 45° L and R	1
High Risk Factors	/ 3
Low Risk Factors	/ 5

Interpretation (stepwise)
High risk ≥1	Radiography indicated — Do NOT assess ROM. Image the c-spine.
Low risk = 0	Cannot assess ROM safely — No low-risk factor present to allow safe assessment. Image.
Low risk ≥1 + ROM OK	C-spine can be cleared — At least one low-risk factor AND able to rotate neck 45°. No imaging needed.
Low risk ≥1 + no ROM	Radiography indicated — Low-risk factor present but unable to rotate. Image.

References
Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-Spine Rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-1848. PMID 11597285. Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-Spine Rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510-2518. PMID 14695411.