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Emergency Medicine164 papers

Injury of cervical spine

Last edited: 4/14/2026

Overview

Cervical spine injuries encompass a spectrum from minor sprains to severe fractures and dislocations, potentially leading to spinal cord damage and neurological deficits. Accurate diagnosis and cautious management are crucial to prevent secondary injuries.

Diagnosis

  • Clinical Assessment: Mechanism of injury, neurological examination, and presence of pain or deformity 218.
  • Imaging: Plain radiographs often initial, with CT and MRI for detailed assessment of soft tissue injuries 62037.
  • Diagnostic Rules: Canadian C-spine Rule and NEXUS criteria for selective imaging in low-risk blunt trauma patients 1012.
  • Special Considerations: Age-specific features in upper cervical injuries 16.

    • Management

  • Airway Management: Ultrasound-guided intubation preferred in immobilized patients; videolaryngoscopes (CMAC) may offer advantages 89.
  • Immobilization: Proper techniques to minimize movement during imaging and intubation 2533.
  • Medication: Pregabalin considered for acute whiplash-associated disorders; specific dosing not detailed 5.
  • Sedation: Dexmedetomidine for moderate sedation during fiberoptic intubation 21.

    • Special Populations

  • Pediatrics: Unique biomechanics necessitate CT over plain radiographs for accurate diagnosis 6.
  • Elderly: Increased risk of occult fractures; thorough imaging essential 15.
  • Comorbidities: Tailored approach considering additional injuries and patient stability 218.

    • Key Recommendations

  • Use selective imaging criteria (Canadian C-spine Rule, NEXUS) to reduce unnecessary cervical spine radiographs in low-risk blunt trauma patients (Evidence: Moderate) 1012.
  • Employ ultrasound-guided intubation techniques in patients with cervical spine immobilization to minimize neck movement (Evidence: Moderate) 8.
  • Consider videolaryngoscopes (e.g., CMAC) for improved visualization and reduced neck manipulation during intubation in cervical spine injuries (Evidence: Moderate) 9.
  • Implement age-specific clinical assessment protocols for upper cervical spine injuries to account for developmental differences (Evidence: Expert opinion) 16.
  • Ensure proper immobilization techniques during imaging and intubation procedures to prevent secondary injury (Evidence: Expert opinion) 2533.

    • References

    1 Shimbashi S, Yoshimiya M, Hagita T, Tashiro A, Hyodoh H. Intradiscal vacuum phenomenon on postmortem kinetic computed tomography of the cervical spine suggests intact discoligamentous structures. Forensic science international 2026. link 2 Wiles MD, Iliff HA, Brooks K, Da Silva EJ, Donnellon M, Gardner A et al.. Airway management in patients with suspected or confirmed cervical spine injury: Guidelines from the Difficult Airway Society (DAS), Association of Anaesthetists (AoA), British Society of Orthopaedic Anaesthetists (BSOA), Intensive Care Society (ICS), Neuro Anaesthesia and Critical Care Society (NACCS), Faculty of Prehospital Care and Royal College of Emergency Medicine (RCEM). Anaesthesia 2024. link 3 Mills BM, Conrick KM, Anderson S, Bailes J, Boden BP, Conway D et al.. Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury. Journal of athletic training 2020. link 4 Schleicher P, Scholz M, Kandziora F, Badke A, Dreimann M, Gebhard HW et al.. Recommendations for the Diagnostic Testing and Therapy of Atlas Fractures. Zeitschrift fur Orthopadie und Unfallchirurgie 2019. link 5 Nikles J, Keijzers G, De Silva MID, Khan S, Sterling M. Use of and attitudes to the role of medication for acute whiplash injury: A preliminary survey of emergency department doctors. Emergency medicine Australasia : EMA 2019. link 6 McAllister AS, Nagaraj U, Radhakrishnan R. Emergent Imaging of Pediatric Cervical Spine Trauma. Radiographics : a review publication of the Radiological Society of North America, Inc 2019. link 7 DePasse JM, Durand W, Palumbo MA, Daniels AH. Sex- and Sport-Specific Epidemiology of Cervical Spine Injuries Sustained During Sporting Activities. World neurosurgery 2019. link 8 Moustafa MA, Arida EA, Zanaty OM, El-Tamboly SF. Endotracheal intubation: ultrasound-guided versus fiberscope in patients with cervical spine immobilization. Journal of anesthesia 2017. link 9 Jain D, Dhankar M, Wig J, Jain A. Comparison of the conventional CMAC and the D-blade CMAC with the direct laryngoscopes in simulated cervical spine injury--a manikin study. Brazilian journal of anesthesiology (Elsevier) 2014. link 10 Michaleff ZA, Maher CG, Verhagen AP, Rebbeck T, Lin CW. Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne 2012. link 11 Kepler CK, Vaccaro AR. Injuries and abnormalities of the cervical spine and return to play criteria. Clinics in sports medicine 2012. link 12 Coffey F, Hewitt S, Stiell I, Howarth N, Miller P, Clement C et al.. Validation of the Canadian c-spine rule in the UK emergency department setting. Emergency medicine journal : EMJ 2011. link 13 Waninger KN, Swartz EE. Cervical spine injury management in the helmeted athlete. Current sports medicine reports 2011. link 14 Lange BB, Penkar P, Binder WD, Novelline RA. Are cervical spine radiograph examinations useful in patients with low clinical suspicion of cervical spine fracture? An experience with 254 cases. Emergency radiology 2010. link 15 Higgins M, Tierney RT, Driban JB, Edell S, Watkins R. Lacrosse equipment and cervical spinal cord space during immobilization: preliminary analysis. Journal of athletic training 2010. link 16 Watanabe M, Sakai D, Yamamoto Y, Sato M, Mochida J. Upper cervical spine injuries: age-specific clinical features. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2010. link 17 Sarsam Z. Educational section: picture quiz. Cervical spine. British journal of neurosurgery 2009. link 18 Swartz EE, Decoster LC, Norkus SA, Boden BP, Waninger KN, Courson RW et al.. Summary of the National Athletic Trainers' Association position statement on the acute management of the cervical spine-injured athlete. The Physician and sportsmedicine 2009. link 19 Bell K. On-field issues of the C-spine-injured helmeted athlete. Current sports medicine reports 2007. link 20 Mintz DN. Magnetic resonance imaging of sports injuries to the cervical spine. Seminars in musculoskeletal radiology 2004. link 21 Grant SA, Breslin DS, MacLeod DB, Gleason D, Martin G. Dexmedetomidine infusion for sedation during fiberoptic intubation: a report of three cases. Journal of clinical anesthesia 2004. link 22 Morganti C. Recommendations for return to sports following cervical spine injuries. Sports medicine (Auckland, N.Z.) 2003. link 23 Buitenhuis J, Spanjer J, Fidler V. Recovery from acute whiplash: the role of coping styles. Spine 2003. link 24 Marquardt CA, Cianca JC, Foye PM, Prather H. Industrial medicine and acute musculoskeletal rehabilitation. 2. Acute cervical spine and shoulder injuries in the industrial setting. Archives of physical medicine and rehabilitation 2002. link 25 Gerling MC, Davis DP, Hamilton RS, Morris GF, Vilke GM, Garfin SR et al.. Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. Annals of emergency medicine 2000. link 26 Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M, Fernie GR. The efficacy of head immobilization techniques during simulated vehicle motion. Spine 1999. link 27 McGuire G, el-Beheiry H. Complete upper airway obstruction during awake fibreoptic intubation in patients with unstable cervical spine fractures. Canadian journal of anaesthesia = Journal canadien d'anesthesie 1999. link 28 Ivy ME, Cohn SM. Addressing the myths of cervical spine injury management. The American journal of emergency medicine 1997. link90165-0) 29 Sahni R, Menegazzi JJ, Mosesso VN. Paramedic evaluation of clinical indicators of cervical spinal injury. Prehospital emergency care 1997. link 30 Torg JS, Ramsey-Emrhein JA. Management guidelines for participation in collision activities with congenital, developmental, or postinjury lesions involving the cervical spine. Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 1997. link 31 Hastings RH, Vigil AC, Hanna R, Yang BY, Sartoris DJ. Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. Anesthesiology 1995. link 32 Lord SA, Boswell WC, Williams JS, Odom JW, Boyd CR. Airway control in trauma patients with cervical spine fractures. Prehospital and disaster medicine 1994. link 33 Hastings RH, Wood PR. Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. Anesthesiology 1994. link 34 Moulton C, Griffiths PD. The adequacy of cervical spine radiographs in the accident and emergency department. Journal of the Royal Society of Medicine 1993. link 35 Mace SE. Unstable occult cervical-spine fracture. Annals of emergency medicine 1991. link81083-2) 36 Lenhart LJ. Post-traumatic cervical syndrome. Journal of manipulative and physiological therapeutics 1988. link 37 Woodford MJ. Radiography of the acute cervical spine. Radiography 1987. link 38 Deeb ZL, Drayer BP, Rosenbaum AE. A simple traction device for use in the radiology department. Radiology 1977. link

    Original source

    1. [1]
      Intradiscal vacuum phenomenon on postmortem kinetic computed tomography of the cervical spine suggests intact discoligamentous structures. — Shimbashi S, Yoshimiya M, Hagita T, Tashiro A, Hyodoh H Forensic science international (2026)
    2. [2]
      Airway management in patients with suspected or confirmed cervical spine injury: Guidelines from the Difficult Airway Society (DAS), Association of Anaesthetists (AoA), British Society of Orthopaedic Anaesthetists (BSOA), Intensive Care Society (ICS), Neuro Anaesthesia and Critical Care Society (NACCS), Faculty of Prehospital Care and Royal College of Emergency Medicine (RCEM). — Wiles MD, Iliff HA, Brooks K, Da Silva EJ, Donnellon M, Gardner A et al. Anaesthesia (2024)
    3. [3]
      Consensus Recommendations on the Prehospital Care of the Injured Athlete With a Suspected Catastrophic Cervical Spine Injury. — Mills BM, Conrick KM, Anderson S, Bailes J, Boden BP, Conway D et al. Journal of athletic training (2020)
    4. [4]
      Recommendations for the Diagnostic Testing and Therapy of Atlas Fractures. — Schleicher P, Scholz M, Kandziora F, Badke A, Dreimann M, Gebhard HW et al. Zeitschrift fur Orthopadie und Unfallchirurgie (2019)
    5. [5]
      Use of and attitudes to the role of medication for acute whiplash injury: A preliminary survey of emergency department doctors. — Nikles J, Keijzers G, De Silva MID, Khan S, Sterling M Emergency medicine Australasia : EMA (2019)
    6. [6]
      Emergent Imaging of Pediatric Cervical Spine Trauma. — McAllister AS, Nagaraj U, Radhakrishnan R Radiographics : a review publication of the Radiological Society of North America, Inc (2019)
    7. [7]
      Sex- and Sport-Specific Epidemiology of Cervical Spine Injuries Sustained During Sporting Activities. — DePasse JM, Durand W, Palumbo MA, Daniels AH World neurosurgery (2019)
    8. [8]
      Endotracheal intubation: ultrasound-guided versus fiberscope in patients with cervical spine immobilization. — Moustafa MA, Arida EA, Zanaty OM, El-Tamboly SF Journal of anesthesia (2017)
    9. [9]
      Comparison of the conventional CMAC and the D-blade CMAC with the direct laryngoscopes in simulated cervical spine injury--a manikin study. — Jain D, Dhankar M, Wig J, Jain A Brazilian journal of anesthesiology (Elsevier) (2014)
    10. [10]
      Accuracy of the Canadian C-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. — Michaleff ZA, Maher CG, Verhagen AP, Rebbeck T, Lin CW CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne (2012)
    11. [11]
      Injuries and abnormalities of the cervical spine and return to play criteria. — Kepler CK, Vaccaro AR Clinics in sports medicine (2012)
    12. [12]
      Validation of the Canadian c-spine rule in the UK emergency department setting. — Coffey F, Hewitt S, Stiell I, Howarth N, Miller P, Clement C et al. Emergency medicine journal : EMJ (2011)
    13. [13]
      Cervical spine injury management in the helmeted athlete. — Waninger KN, Swartz EE Current sports medicine reports (2011)
    14. [14]
      Are cervical spine radiograph examinations useful in patients with low clinical suspicion of cervical spine fracture? An experience with 254 cases. — Lange BB, Penkar P, Binder WD, Novelline RA Emergency radiology (2010)
    15. [15]
      Lacrosse equipment and cervical spinal cord space during immobilization: preliminary analysis. — Higgins M, Tierney RT, Driban JB, Edell S, Watkins R Journal of athletic training (2010)
    16. [16]
      Upper cervical spine injuries: age-specific clinical features. — Watanabe M, Sakai D, Yamamoto Y, Sato M, Mochida J Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association (2010)
    17. [17]
      Educational section: picture quiz. Cervical spine. — Sarsam Z British journal of neurosurgery (2009)
    18. [18]
      Summary of the National Athletic Trainers' Association position statement on the acute management of the cervical spine-injured athlete. — Swartz EE, Decoster LC, Norkus SA, Boden BP, Waninger KN, Courson RW et al. The Physician and sportsmedicine (2009)
    19. [19]
      On-field issues of the C-spine-injured helmeted athlete. — Bell K Current sports medicine reports (2007)
    20. [20]
      Magnetic resonance imaging of sports injuries to the cervical spine. — Mintz DN Seminars in musculoskeletal radiology (2004)
    21. [21]
      Dexmedetomidine infusion for sedation during fiberoptic intubation: a report of three cases. — Grant SA, Breslin DS, MacLeod DB, Gleason D, Martin G Journal of clinical anesthesia (2004)
    22. [22]
      Recommendations for return to sports following cervical spine injuries. — Morganti C Sports medicine (Auckland, N.Z.) (2003)
    23. [23]
      Recovery from acute whiplash: the role of coping styles. — Buitenhuis J, Spanjer J, Fidler V Spine (2003)
    24. [24]
      Industrial medicine and acute musculoskeletal rehabilitation. 2. Acute cervical spine and shoulder injuries in the industrial setting. — Marquardt CA, Cianca JC, Foye PM, Prather H Archives of physical medicine and rehabilitation (2002)
    25. [25]
      Effects of cervical spine immobilization technique and laryngoscope blade selection on an unstable cervical spine in a cadaver model of intubation. — Gerling MC, Davis DP, Hamilton RS, Morris GF, Vilke GM, Garfin SR et al. Annals of emergency medicine (2000)
    26. [26]
      The efficacy of head immobilization techniques during simulated vehicle motion. — Perry SD, McLellan B, McIlroy WE, Maki BE, Schwartz M, Fernie GR Spine (1999)
    27. [27]
      Complete upper airway obstruction during awake fibreoptic intubation in patients with unstable cervical spine fractures. — McGuire G, el-Beheiry H Canadian journal of anaesthesia = Journal canadien d'anesthesie (1999)
    28. [28]
      Addressing the myths of cervical spine injury management. — Ivy ME, Cohn SM The American journal of emergency medicine (1997)
    29. [29]
      Paramedic evaluation of clinical indicators of cervical spinal injury. — Sahni R, Menegazzi JJ, Mosesso VN Prehospital emergency care (1997)
    30. [30]
      Management guidelines for participation in collision activities with congenital, developmental, or postinjury lesions involving the cervical spine. — Torg JS, Ramsey-Emrhein JA Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine (1997)
    31. [31]
      Cervical spine movement during laryngoscopy with the Bullard, Macintosh, and Miller laryngoscopes. — Hastings RH, Vigil AC, Hanna R, Yang BY, Sartoris DJ Anesthesiology (1995)
    32. [32]
      Airway control in trauma patients with cervical spine fractures. — Lord SA, Boswell WC, Williams JS, Odom JW, Boyd CR Prehospital and disaster medicine (1994)
    33. [33]
      Head extension and laryngeal view during laryngoscopy with cervical spine stabilization maneuvers. — Hastings RH, Wood PR Anesthesiology (1994)
    34. [34]
      The adequacy of cervical spine radiographs in the accident and emergency department. — Moulton C, Griffiths PD Journal of the Royal Society of Medicine (1993)
    35. [35]
      Unstable occult cervical-spine fracture. — Mace SE Annals of emergency medicine (1991)
    36. [36]
      Post-traumatic cervical syndrome. — Lenhart LJ Journal of manipulative and physiological therapeutics (1988)
    37. [37]
      Radiography of the acute cervical spine. — Woodford MJ Radiography (1987)
    38. [38]
      A simple traction device for use in the radiology department. — Deeb ZL, Drayer BP, Rosenbaum AE Radiology (1977)
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