Management of Cervical Spine Traumatic Injuries

Assessment and Classification

The Subaxial Injury Classification (SLIC) System provides excellent reliability for grading instability and fracture patterns in cervical spine traumatic injuries, as recommended by the American Association of Neurological Surgeons 1
CT imaging is essential for detailed assessment of fracture pattern and displacement, particularly in acute injuries, according to the American College of Radiology 2
MRI may be indicated when ligamentous injury is suspected, as disruption of the discoligamentous complex significantly impacts stability and treatment decisions, as suggested by the American Association of Neurological Surgeons 1

A SLIC score ≥5 indicates need for surgical intervention, as recommended by the American Association of Neurological Surgeons 1
Surgery is indicated for C1 fractures with neurological deficit attributable to the fracture, according to the American Association of Neurological Surgeons 1

When airway management is required in patients with cervical spine injuries, attempts should be made to minimize cervical spine movement during pre-oxygenation and facemask ventilation, as recommended by the American Society of Anesthesiologists 3, 4
Jaw thrust should be used rather than head tilt plus chin lift when a simple maneuver is required to maintain an airway in these patients, according to the American Society of Anesthesiologists 3, 4

The evidence base for specific cervical fracture subtypes is limited, with few comparative studies providing level II evidence or higher, as noted by the Journal of Neurosurgery 5, 6, 7

Early immobilization of the spine is recommended in any traumatized patient with suspected spinal cord injury to limit the onset or aggravation of neurological deficit 8
For pre-hospital management, manual in-line stabilization combined with removal of the anterior part of the cervical collar during tracheal intubation is suggested to limit cervical spine mobilization while promoting glottic exposure 8
For pre-hospital tracheal intubation, a procedure integrating rapid induction with direct laryngoscopy, use of a gum elastic bougie, and retention of the cervical spine in the axis without Sellick maneuver is recommended to increase first-attempt success 8

The evidence base for specific cervical fracture subtypes is limited, with few comparative studies providing level II evidence or higher 9
The standardized and systematic approach to cervical spine fractures using evidence-based methodology has merit and potential to identify optimal strategies for assessment, characterization, and clinical management 9
The application of evidence-based medicine to identify ideal treatment strategies for individual cervical fracture injuries is inherently difficult due to the lack of high-quality comparative studies 9