Teaching Points
- Canadian C-spine rules provide an algorithm to determine if imaging is required for a possible injury:
- Imaging is required if any high risk factors are present, or low risk factors are absent or the patient is unable to rotate their neck actively
- High risk factors - Age ≥65, dangerous mechanism of injury, paraesthesia of the limbs.
- Low risk factors; Simple rear end motor vehicle collision or sitting position in the emergency department, ambulatory at any time, delayed neck pain, no midline tenderness.
- Imaging is required if any high risk factors are present, or low risk factors are absent or the patient is unable to rotate their neck actively
- 3 view radiography +/- oblique views in young patients.
- In older patients, situations where technical difficulties in obtaining adequate plain films are likely to arise or a CT is being performed for another indication, MDCT of the spine may be preferable.
- MRI is useful for pre-surgical planning, assessment of soft tissue injuries and should be considered if there are neurological signs.
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