Resource

Under Review

Under Review

09/07/25

09 July 2025

Secondary survey - C-spine

NAIF Post Fall Medical Examination 03 C Spine

i. History

  • Was the fall from height (eg over the rails of a raised bed) or because of syncope? 
  • Does the patient have a history of spinal fracture, or do they have / are at risk of osteoporosis or other spinal pathology?
  • Have you already identified external evidence of head or facial injuries?
  • Is the patient complaining of new neck pain?

 

ii. Examination

  • Is there obvious new neck or spinal deformity?
  • Palpate for midline tenderness.
  • Any abnormal neurology?
  • If C-spine injury is suspected at this stage using flowchart below (Fig 2) to assist decision, progress to immobilising C-spine and do not move neck further.
  • Follow flowchart below (Fig 2) – if deemed safe, assess neck movement by asking patient to rotate neck 45° to the right and left.

 

iii. Management

Follow flowchart below (Fig 2) to determine whether a CT scan of the C-spine is required. Clear communication with radiology is required to organise appropriate manual handling for an immobilised patient.

Follow guidance for imaging as per NICE guideline NG232:

Fig 2. Algorithm for selecting people 16 and over for imaging of the cervical spine
Image 2. C Spine
Figure 2. Algorithm for selecting people 16 and over for imaging of the cervical spine

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