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.
- Age> 65
- Trauma such as fall > 1 meter or 5 stairs, axial loadingto head and neck (diving), high- speed MVA, or recreational vehicle injury, bicycle collision.
- Paresthesiain extremities.
- 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
- Normal sitting posture
- Delayed onset of pain
- 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. physio-pedia.com. 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.