Canadian Cervical Spine Rules

Authors

Affiliations

Nate Yomogida, B.S., SPT

Doctor of Physical Therapy

B.S. in Kinesiology

Chloë Kerstein, B.S., SPT

Doctor of Physical Therapy

B.A. in Neuroscience

Rule not applicable if:

• Non-trauma cases
• GCS <15
• Unstable vital signs
• Age < 16 years
• Acute paralysis
• Known vertebral disease
• Previous C/S surgery
• Pregnant

High Risk Factors

• Age >= 65y/o
• Dangerous mechanism
  • Fall from elevation (>=3ft or >=5 stairs)
  • Axial load to the head
  • MVC at high speeds (>100km/hr or 60 mph), rollover, or ejection
  • Motorized recreational vehicle
  • Bike struck or collision
• New parasthesias in extremities
• C/S rotation < 45°

Low Risk factors

If the patient presents with these, you should rule down the necessity for radiography:

• Simple rear-end MVC
• Tolerates sitting position in ED
• Ambulatory at any time
• Delayed onset of pain
• Absence of midline C/S tenderness

Simple MVC exclusions

• Pushed into oncoming traffic
• hit by bus or large truck
• Rollover