• Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • General Ortho
  • Procedures
  • Spine
  • Upper Limb
  • Lower Limb
  • Pain
  • Trauma
  • Tumors
  • Newsletter/Updates
  • About Us
  • Contact Us

Bone and Spine

Orthopedic health, conditions and treatment

Canadian C-spine Rule

By Dr Arun Pal Singh

In this article
    • How to Apply Canadian C-spine Rule

Canadian C-Spine Spine Rule For Risk of Skeletal Injury

Canadian C-spine rule is for use of radiography in cervical spine injuries. Cervical spine injury has the potential for neurological injury and various protocols have been developed to protect the C-spine from field to hospital emergency care.

These protective measures like a backboard, collar and sandbags are used in all trauma patients with or without neck symptoms.

To rule out cervical injury, cervical imaging is done in patients of trauma. 97% trauma centers in US were found to order cervical spine radiography for all trauma patients and the rate of imaging varies in hospitals.

It is reported that less than 3% of the trauma series have any positive finding. Therefore universal cervical spine radiography is considered inefficient and not cost effective.

Canadian C-spine rule is a set of guidelines that aim to reduce unnecessary cervical spine imaging and reduce health care costs.
Canadian C-spine rule was developed because there is a controversy among emergency physicians, neurosurgeons and trauma surgeons regarding the indications for C-spine radiography.

The different existing guidelines are confusing. Some say that all trauma patients should undergo imaging. Advanced Trauma Life Support course recommends that cervical spine films be obtained on all patients with injuries above the clavicle.

Some centers have a physician based selective approach where the decision to get an x-ray or not lies with a clinician.
Canadian C-spine rule for risk of skeletal injury aims to provide a universal protocol for cervical imaging in alert and stable patients. Canadian C-spine rule has been reported to be safe and reliable though there is a report of missing one unstable injury.

Here is an image showing Canadian C-spine rule.

Canadian C-Spine Rule
Canadian C-Spine Rule

How to Apply Canadian C-spine Rule

The Canadian cervical spine rule applies to trauma patients who are alert (Glasgow coma scale of 15) and stable.

The rule is not applicable in

  • Nontrauma cases
  • GCS<15
  • Unstable vital signs
  • Age<16 years
  • Acute paralysis
  • Known disease of the vertebra
  • Any previous cervical spine injury

For assessing a patient with cervical spine injury for the need of x-ray, first look for high-risk factors

High-Risk Factors

  • Age 65 years or over.
  • Paraesthesia in extremities.
  • Dangerous mechanism of injury, which is considered to be
    • A fall from a height of at least a meter or five stairs.
    • An axial load to the head – eg, during diving.
    • A motor vehicle collision at high speed (>100 km/h) or with rollover or ejection.
    • A collision involving a motorised recreational vehicle.
    • A bicycle collision.

If a high-risk factor is present, radiography is required.

If there are no high-risk factors, look for low-risk factors

Low Risk Factors

  • Simple rear-end motor vehicle collision (excludes being pushed into oncoming traffic, being hit by a bus or a large truck, a rollover, and being hit by a high-speed vehicle).
  • The patient is able to sit or is sitting in the emergency department.
  • The patient is ambulatory at any time.
  • The onset of neck pain is delayed [The pain did not occur immediately after the injury after some time]
  • An absence of midline cervical spine tenderness.

If any low-risk factor is present, the patient is asked to rotate the neck to 45 degrees.

Able to Rotate Neck

If the patient is able to rotate the neck, 45 degrees on either side [left and right], then no radiography is required.

If the patient is not able to rotate 45 degrees on either side [left and right]then radiography is required.

Spread the Knowledge
  • 11
    Shares
  •  
    11
    Shares
  • 2
  • 9
  •  
  •  
  •  

Filed Under: Spine

About Dr Arun Pal Singh

Arun Pal Singh is an orthopedic and trauma surgeon, founder and chief editor of this website. He works in Kanwar Bone and Spine Clinic, Dasuya, Hoshiarpur, Punjab.

This website is an effort to educate and support people and medical personnel on orthopedic issues and musculoskeletal health.

You can follow him on Facebook, Linkedin and Twitter

Reader Interactions

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Primary Sidebar

weight bearing devices for orthosis

Lower Limb Orthoses – Components and Functions

Lower limb orthoses are advised for a variety of dysfunctions of the lower limb. Most of the lower limb orthoses use prefabricated components which are made of either stainless steel or aluminum. Stainless steel is more durable but aluminum is lighter. Below Knee Orthoses Below knee orthosis has a primary function of controlling ankle joint. It […]

Do backpacks cause back pain children

Do Backpacks Cause Back Pain in Children?

Back pain in children is not that common and often may be associated with underlying disorders. However, recent evidence has suggested backpacks in school going children to be a cause of back pain. The school going does involve carrying backpacks filled with books and materials and is continuing to be so in future time, it […]

Sinding Larsen Johansson disease

Sinding Larsen Johansson Disease

Sinding Larsen Johansson disease [ also known as Sinding-Larsen disease or Larsen-Johannson syndrome] is a type of osteochondrosis that affects the proximal end of the patellar tendon as it inserts into the inferior pole of the patella, and represents a chronic traction injury or overuse injury of the immature osteotendinous junction. It is a closely […]

Spondylolisthesis of L5 over S1

Spondylolisthesis – Presentation and Treatment

The term spondylolisthesis  derived from the Greek spondylos, meaning “vertebra,” and olisthenein, meaning “to slip.” Spondylolisthesis is defined as anterior or posterior slipping of one segment of the spine on the next lower segment. Classification of Spondylolisthesis There are two classifications of spondylolisthesis. One is by Wiltse, Newman, and Macnab’s classification of and other is […]

infrapatellar bursitis

Infrapatellar Bursitis – Presentation and Treatment

Infrapatellar bursitis is inflammation of the infrapatellar bursa, a fluid-filled sac located just below the patella or kneecap. The superficial infrapatellar bursa is located between the patellar tendon and the skin. It lies anterior to patellar tendon and is subcutaneous.   The deep infrapatellar bursa is situated between the patellar ligament and the upper front […]

rib-cage

Rib Fractures – Causes, Presentation and Treatment

Rib fractures are the most common injury sustained after blunt chest trauma. Rib fractures are more common in elderly and adults [older people are more prone than young adults] than children. Elderly are more likely to have associated injuries and complications. Rib fractures can be associated with injury to internal organs. This includes injury to […]

Approach to renal rickets

Renal Rickets

Renal rickets is the term used for rickets where the primary cause is not vitamin D deficiency but a renal disease leading to events that cause rickets or osteomalacia. [More about rickets] [More on Osteomalacia] Renal rickets is known by various names. Renal dwarfism, renal pseudorickets, and renal osteitis fibrosa cystica are forms of renal-caused […]

Browse Articles

Footer

Pages

  • About
    • Policies
    • Contact Us

Featured Article

Dynamic Compression Plate Fixation Procedure for Forearm

A patient with fracture proximal radius and ulna was treated by dynamic compression Plate fixation.Fractures of forearm bones [radius or ulna or … [Read More...] about Dynamic Compression Plate Fixation Procedure for Forearm

Search Articles

© Copyright: BoneAndSpine.com