Cervical spine injury: clinical and medico-legal overview

Abstract

Spinal trauma is an important cause of disability worldwide. Injury to the cervical spine (CS) occurs frequently after major trauma. 5-10% of patients with blunt trauma have a cervical spine injury. The cervical spine accounts for ~ 50% of all spinal injuries. Determination of CS stability is a common challenge in the acute care setting of patients with trauma. Several issues, indeed, are of particular concern: who needs CS imaging; what imaging should be obtained; when should computed tomography (CT), magnetic resonance imaging (MRI), or flexion/extension (F/E) radiographs be obtained; and how is significant ligamentous injury excluded in the comatose patient. CT and MRI both have roles to play. This article aims to present the different imaging to frame techniques to be used with greater precision in the acute event also for the purpose of planning the next therapeutic process. An overview of the applicability of the same methods in forensic pathology is also provided highlighting possible future biomarker to ease in diagnosis of acute TBI.

Keywords: Canadian C-spine rule; Cervical spine imaging; Cervical spine injury; NEXUS criteria; Post-mortem imaging.

Fig. 1

Burst fracture, CT scan axial view

Fig. 2

Burst fracture, CT scan, sagittal view

Fig. 3

Wedge fracture, MRI, sagittal view

Fig. 4

Rotational fracture-dislocation mechanism, CT scan, coronal view

Fig. 5

Rotational fracture-dislocation mechanism, CT scan, sagittal view

Fig. 6

The Canadian C-spine Rule. For patients with a GCS (Glasgow Coma Scale) 15, hemodynamic stability, the presence of risk factors guides the role of imaging. Dangerous mechanisms describes falls ≥ 5 stairs, high-speed (> 100 km/h) impacts, ejections from vehicle, bicycle collision