CT Cervical Spine [ED]
CTWithin 1 hour
ED
All imaging requests must be justified by an IR(ME)R practitioner (radiologist or radiographer)Required Assessment Tools
REQUIRED
Canadian C-Spine Rule
Clinical decision tool for cervical spine imaging — NOT NEXUS
If any high-risk factor present → image
High-risk factors — image if ANY present
Within 1 hour— ANY of the following
- Age ≥65 years
- Dangerous mechanism (fall >1 m, axial load, high-speed MVC, ejection, bicycle/equestrian collision)
- Paraesthesia in upper or lower extremities
- GCS ≤12 or intubated
- Focal peripheral neurological deficit
- Pre-existing spinal pathology (axial spondyloarthritis, known cervical stenosis)
- Other body regions being scanned — include c-spine opportunistically
- Unable to assess clinically (intoxicated, distracting injury, reduced consciousness)
- C-spine tenderness on palpation
- Unable to rotate neck 45° bilaterally
Clinical clearance — no imaging required
— ALL of the following must be met to clear the cervical spine clinically — if any criterion is NOT met, image
- Alert, stable, no distracting injury, no intoxication
- No midline c-spine tenderness
- Low-risk mechanism
- Able to rotate neck 45° left and right
Notes
Warning
Plain X-ray no longer recommended for adult trauma (NG41)
NICE NG41Information
Canadian C-Spine Rule principles embedded — NOT NEXUS
Information
If CT confirms new fracture, image entire remaining spinal column (NG41 Rec 1.5.7)
NICE NG41Radiation Dose
CT cervical spine effective dose ~3–4 mSv
Paediatric
Children <16: MRI is first-line for suspected cervical cord/column injury (NG41 Recs 1.5.2–1.5.4). Do NOT use whole-body CT for children.
Change Log
v1.02026-03-05Initial publication
v2.02026-03-08Canadian C-Spine Rule confirmed (not NEXUS). Expanded high-risk factor list. Paediatric note added.