Cervical spine injury and clearance in trauma

Meet the patient

A 42-year-old man arrives 30 minutes after a high-speed rollover crash at 110 km per hour. He was the restrained driver, extracted by paramedics in a rigid collar with head blocks. His GCS is 15, he is not intoxicated, and he complains of midline cervical tenderness at C5 and paraesthesia in both hands. The collar stays on until the clearance is confirmed.[1]

Two questions decide his next 30 minutes: can I clear this clinically, or does he need a CT? and if the CT is normal but the paraesthesia persists, what is the next test? The dangerous mechanism (a rollover at 110 km per hour) is a high-risk factor under the Canadian C-spine rule — he needs the CT. And if the CT is normal but the deficit persists, the MRI is the definitive test, because a normal CT does not exclude a purely ligamentous or a cord injury.[2]

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