Management of Cervical Spine Fractures: A Literature Review

Abstract

The unique anatomy and flexibility of the cervical spine predispose it to a risk of injury. Trauma to the cervical spine encompasses a wide range of injuries from minor muscular strains to life-threatening fracture-dislocations associated with spinal cord lesions. Initial assessment and management should follow the Advanced Trauma Life Support (ATLS) protocols with adequate protection of the cervical spine through triple immobilisation to prevent any unnecessary movement, which can make the patient susceptible to further neurological injuries. Although the presence of cervical spine injury is very often overt, reliance on clinical examination alone is sometimes not sufficient and potentially requires further imaging. Clinical decision rules such as the Canadian C-Spine Rule are frequently used to risk-stratify patients needing radiography. The level of cervical spine instability and knowledge of their unique classification systems is of paramount importance and assists in the decision-making process to guide definitive management. In this review, we also propose an algorithm to aid the initial management of a patient with suspected cervical spine injury in the emergency department.

Keywords: c-spine; cervical spine; cervical spine fracture; cervical trauma.

Figure 1. The Canadian C-Spine Rule algorithm for patients who are alert (GCS score of 15) and in stable condition with suspected cervical spine injury to guide further imaging.

[6] GCS, Glasgow Coma Scale

Figure 2. Algorithm for the management of suspected cervical spinal fractures in the emergency department.