You are here

Cervical Spine Trauma

synonyms: cervical spine trauma, 

Cervical Spine Trauma ICD-9

Cervical Spine Trauma Etiology / Epidemiology / Natural History

  • Typically high energy trauma
  • Associated the American Football, spear tackling. 

Cervical Spine Trauma Anatomy

Cervical Spine Trauma Clinical Evaluation

  • Palpate entire spine for tenderness / step off.
  • Complete neuro exam: motor strength, pin-prick sensation, reflexes, cranial nerves, rectal examination (perineal pin-prick sensation, sphincter tone, volitional spincter control)
  • Absence of the bulbocaverosus reflex indicates spinal shock. Level of spinal injury can not be determined until bulbocaverosus reflex has returned.
  • See ASIA form.

Cervical Spine Trauma Xray / Diagnositc Tests

  • Lateral c-spine generally taken as part of ATLS for patients who are unstable.
  • A/P, Lateral, Odontoid, views indicated for high risk patients: (1)older than 65y/o, (2)paresthesias in the extremities, (3) dangerous injury mechansim. Imaging is not required in low-risk patients who ccan activtely rotate the neck 45° to the right and left. Low-risk:(1)simple rear end collision, able to maintain sitting position, (3)ambulatory, (4) delayed onset neck pain, (5)absence of midline c-spine tenderness. (Stiell IG, JAMA 2001;286:1841).
  • CT cervical spine: indicated for obtunded patients before c-spine clearance. Better cost-effectivness, sensitiivty and safety than screening xrays, but exposes patients to 6x more radiaiton.
  • MRI: indicated for neuro deficit, suspicious of instability or HNP, pre-op evaluation

Cervical Spine Trauma Classification / Treatment

  • Any trauma pt with suspected C-spine injury should be immobilized on a spine board with cervical collar and log-roll precautions until the c-spine has been cleared.
  • Protective equipement such as the helmet and shoulder pads should be left in place.  Removal risks progressive neurologic injury from a potentially unstable cervical spine injury. Removal of the face mask alone is typically performed allow airway access.
  • C-spine Fracture/dislocatio, closed reduction in awake, cooperative patient: closed reduction with Gardner-Wells tongs/traction with serial neuro exams and xrays.
  • See Differential Diagnosis for specific injuries / treatments.

Cervical Spine Trauma Differential Diagnosis

  • Occipital Condyle Fracture
  • Occipitocervical Dissociation
  • Atlas fracture
  • C2 fracture
  • Odontoid fracture
  • Facet Dislocation
  • Facet Fracture
  • Burst Fracture
  • Compression Fracture
  • Teardrop Fractures
  • Spinal Cord Injury

Cervical Spine Trauma Complications

Cervical Spine Trauma Follow-up Care

Cervical Spine Trauma Review References

  • Boden BP, Tacchetti RL, Cantu RC, Knowles SB, Mueller FO. Catastrophic cervical spine injuries in high school and college football players. Am J Sports Med. 2006 Aug;34(8):1223-32.
  • Mall NA, Buchowski J, Zebala L, Brophy RH, Wright RW, Matava MJ. Spine and axial skeleton injuries in the National Football League. Am J Sports Med. 2012 Aug;40(8):1755-61.
  • Rihn JA, Anderson DT, Lamb K, Deluca PF, Bata A, Marchetto PA, Neves N,Vaccaro AR. Cervical spine injuries in American football. Sports Med. 2009;39(9):697-708. 
  • °


The information on this website is intended for orthopaedic surgeons.  It is not intended for the general public. The information on this website may not be complete or accurate.  The eORIF website is not an authoritative reference for orthopaedic surgery or medicine and does not represent the "standard of care".  While the information on this site is about health care issues and sports medicine, it is not medical advice. People seeking specific medical advice or assistance should contact a board certified physician.  See Site Terms / Full Disclaimer