Canadian Cervical Spine Rule

Canadian Cervical spine Rule [i] [ii]


The Canadian “C” spine rule is a tool used to determine the necessity of radiology after cervical trauma.  It is used on patients who are alert and in stable condition following a trauma and when cervical spine injury is a concern.  It does not apply to non-traumatic cases, if the patient has unstable vital signs, acute paralysis, has known vertebral disease or has a previous history of cervical spine surgery and if they are less than 16 years old.


Rule: High- Risk Factors


  1. Age> 65
  2. Trauma such as fall > 1 meter or 5 stairs, axial loadingto head and neck (diving), high-  speed MVA, or recreational vehicle injury, bicycle collision.
  3. Paresthesiain extremities.


Rule: Low-Risk Factors that allow safe assessment of ROM


  1. Simple rear end MVA
  • excluding being hit by a bus, large truck, being pushed into oncoming traffic, roll over or being hit by high-speed
  1. Normal sitting posture
  2. Ambulatory
  3. Delayed onset of pain
  4. No midline tenderness of C-spine


Can the patient rotate neck greater than 45 degrees in each direction?

If there is 1 high-risk factor or 2 low-risk factors and the inability to rotate the neck 45 degrees warrants an x-ray.

The evidence shows a sensitivity of 99.4 and a specificity of 45.1.  The negative likelihood ratio associated with this highly sensitive test is less than 5% which means there is only a 5% chance that if you get a negative finding, the patient would still have the condition.

[i] Belot, M et al. Candian C-Spine Rule. n.d. web. Jan 16 2016.

[ii] Stiell, IG et al.  The Canadian C-Spine Rule versus the NEXUS Low- Risk Critieria in Patients with Trauma.  N Engl J Med. 2003 Dec. 25;349 (26):2510-8.

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