Cervical Spine Injuries

Cervical Spine Injuries Head Injury and Traumatic Brain Injury

Cervical Spine Injuries

Cervical spine injuries (CSI) are common after blunt trauma and can cause devastating, preventable neurological harm if not identified and managed promptly. This section summarises practical emergency department (ED) assessment, immobilisation and imaging for adults and children in line with current UK guidance (NICE NG232 and NG41, QS74; Resuscitation Council; RCEM).

Principles

• Primary objective: identify patients at risk of unstable cervical spine injury or spinal cord involvement, prevent secondary injury, and expedite definitive diagnosis and specialist care.
• Life‑saving airway and resuscitation interventions override spinal motion restriction (SMR).
• Use manual in‑line stabilisation during airway manoeuvres; do not delay airway management to maintain a rigid collar.
• Use a validated decision rule for adults (Canadian C‑spine rule, age ≥16) to guide imaging; apply senior clinical judgement and local protocols for patients outside the validation groups.

High‑suspicion mechanisms and risk groups

• High‑energy mechanisms:
• Fall >1 m or >5 stairs
• High‑speed road traffic collision (RTC) or ejection
• Axial load/diving injuries
• Motorcycle, bicycle or motorised recreational vehicle collisions
• Horse‑riding injuries
• Crushing or direct blow to the head/neck