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The majority of the nearly 18,000 new cases of spinal cord injury in the United States each year involve the cervical spine. Although the morbidity, mortality, and healthcare costs associated with these injuries is very high, quality evidence to guide emergency management is limited. Recent changes to guidelines have called into question decades of practice, including prehospital spinal immobilization protocols, timing of surgery, and pharmacotherapy. A systematic approach to the diagnosis and management of the spine-injured patient is outlined in this review, with a focus on recent updates and management of emergent complications.
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Following are the most informative references cited in this paper, as determined by the authors.
2. “National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance.” 2021. Accessed September 10, 2021. (Prospective longitudinal study; 34,734 patients)
7. * Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res. 1984;&NA;(189):65-76. (Cohort study; 412 patients)
22. * Theodore N, Hadley MN, Aarabi B, et al. Prehospital cervical spine immobilization after trauma. Neurosurgery. 2013;72(suppl_3):22-34. (Systematic review and guideline) DOI: 10.1227/NEU.0b013e318276edb1
27. * Hauswald M, Ong G, Tandberg D, et al. Out-of-hospital spinal immobilization: Its effect on neurologic injury. Acad Emerg Med. 1998;5(3):214–219. (Retrospective cohort study; 454 patients) DOI: 10.1111/j.1553-2712.1998.tb02615.x
28. * Oto B, Corey DJ, Oswald J, et al. Early secondary neurologic deterioration after blunt spinal trauma: a review of the literature. Acad Emerg Med. 2015;22(10):1200-1212. (Systematic review) DOI: 10.1111/acem.12765
30. * McDonald NE, Curran-Sills G, Thomas RE. Outcomes and characteristics of non-immobilised, spine-injured trauma patients: a systematic review of prehospital selective immobilisation protocols. Emerg Med J. 2016;33(10):732-740. (Systematic review) DOI: 10.1136/emermed-2015-204693
59. * ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)—what’s new? Spinal Cord. 2019;57(10):815-817. (Practice guideline) DOI: 10.1038/s41393-019-0350-9
61. * Stiell IG, McKnight RD, Schull MJ, et al. The Canadian c-spine rule versus the NEXUS low-risk criteria in patients with trauma. New Engl J Med. 2003:9. (Prospective cohort; 8283 patients) DOI: 10.1056/NEJMoa031375
92. * Cabrini L, Baiardo Redaelli M, Filippini M, et al. Tracheal intubation in patients at risk for cervical spinal cord injury: a systematic review. Acta Anaesthesiol Scand. 2020;64(4):443-454. (Systematic review and meta-analysis; 1972 patients) DOI: 10.1111/aas.13532
101. *Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury: results of the second national acute spinal cord injury study. N Engl J Med. 1990;322(20):1405-1411. (Randomized controlled trial; 487 patients) DOI: 10.1056/NEJM199005173222001
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Keywords: cervical, spine, spinal cord, injury, MVC, motor vehicle crash, neck pain, head, trauma, compression, fracture, flexion, hyperextension, burst, immobilization, motion restriction, guidelines, paresthesia, airway, intubation, NEXUS, Canadian C-Spine, Denver screening, SCIWORA
In This Episode
Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the October 2021 issue of Emergency Medicine Practice: Emergency Department Management of Cervical Spine Injuries (Trauma CME)
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Geoffrey Jara-Almonte, MD; Chandni Pawar, MD
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October 31, 2024
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits
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CME Information
Date of Original Release: October 1, 2021. Date of most recent review: September 10, 2021. Termination date: October 1, 2024.
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Specialty CME: Included as part of the 4 credits, this CME activity is eligible for 4 Trauma CME credits.
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Cover Image: Lateral x-ray of cervical spine showing bilateral facet joint dislocation. Illustration by Yok_onepiece.