Cervical Spine Injuries, NEXUS, and the Combat Medic

The spinal cord is the central nervous highway from the brain to
the rest of our body. It carries the signals that sense pain, activate
C-Spine Injuries, NEXUS, Canadian C-Spine Rules and Traumatic
our voluntary muscles and even control the vital organs. Damage to
these nerves may result in death or serious
Back disability.
Injuries
 Screening a Casualty for Spinal Injuries

Because most trauma patients do not have spinal injuries it is important to identify
as many as possible of those who do not need x-rays/CT scan
CT scans and x-rays are quite expensive and take time- hence several algorithms have
been developed to rule out the need for their use when possible. We will focus on two.

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 Rules for Eliminating the Need for Radiography

NEXUS: The National Emergency X-Radiography Utilization Study (NEXUS) is a set of five
guidelines for medical providers to determine which casualties do not require c-spine
immobilization or MRI/X-rays/CT scan.

Canadian C-Spine Rule: A decision tool developed by Dr. Ian Stiell to determine the need for
radiography in specific casualties.

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 Why Practice C-spine
Immobilization?

Immobilizing trauma patients on a spine board and using a c-collar has been
standard practice for over half a century, why?
It is possible that a fractured vertebrae could shift during the movement of a trauma
casualty and damage or destroy nerves in the spinal column.

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NEXUS Criteria to Determine the Need for C-Spine Immobilization

Applicability: All trauma casualties with MOI consistent w/spinal injuries

1. Focal neurological deficit
2. Mid-line spinal tenderness
3. Altered level of consciousness
4. Intoxication
5. Distracting injury

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NEXUS Criteria Visual

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 Canadian C-Spine Rules

Applicability: Casualties initially presenting with a GCS =15 and stable after
significant trauma. Not for casualties <16yo.
1. High-risk factor present? If so, not clear.
2. Low-risk factor present? If not, not clear.
3. Able to actively rotate neck 45° left and right? If so, clear – radiography is a waste if
these three test components are all clear.

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Canadian C-Spine Rule Visual

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Pros and Cons of Each System of Rules

NEXUS’s system has the advantage of being applicable to all alert casualties, but does
not allow intoxicated casualties or those with distracting injuries to be cleared.
The Canadian C-Spine Rule does allow drunk casualties or those with distracting
injuries to be cleared, but does not apply to pediatrics or geriatrics. According to a
broad study by Canadian trauma centers this system is a bit more accurate and
specific.
Using either rule dependent upon the situation allows for a greater number of
casualties to be cleared.

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References

https://www.racgp.org.au/afp/2012/april/cervical-spine/
https://www.orthobullets.com/spine/2012/cervical-spine-trauma-evaluation
https://www.aci.health.nsw.gov.au/networks/eci/clinical/clinical-resources/clinical-
tools/orthopaedic-and-musculoskeletal/neck-injuries

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