Synopsis
Use reliable clinical rules and age-appropriate imaging to clear the cervical spine, maintain proportionate movement restriction until assessment is complete, and avoid airway, pressure and transfer harm from indiscriminate immobilisation.
- Use manual in-line stabilisation during the primary survey and ask about neck pain, paraesthesia and weakness while assessing all four limbs and sacral function.
- Apply the Canadian C-spine rule only to an alert, stable, cooperative adult for whom the rule is validated; intoxication, distracting injury or reduced consciousness makes clinical clearance unreliable.
- High-risk Canadian features are age 65 or over, dangerous mechanism or limb paraesthesia; these require imaging and no active rotation test.
Key red flags
New limb weakness or numbness, sacral sensory change, priapism, diaphragmatic breathing, loss of anal tone or spinal shock requires emergency spinal-cord assessment and MRI after CT when indicated.
Investigation priorities
Determine whether clinical clearance or imaging is appropriate.
Detect fracture, displacement and major instability when imaging criteria are met.
Management branches
Mechanism, pain, consciousness or neurology creates possible cervical injury.
- Provide manual in-line stabilisation, manage airway and breathing, and avoid forcing deformity into neutral or letting a collar block lifesaving access.
- Document GCS, neck symptoms, all-limb motor and sensory findings and sacral function when cord injury is possible.
The patient is stable enough for clinical decision and imaging where required.