Cervical Disc Injuries Guidelines

Updated: Apr 03, 2022
  • Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Sherwin SW Ho, MD  more...
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Guidelines

Guidelines Summary

American College of Surgeons

The American College of Surgeons (ACS) published guidelines for the management of spine injuries, which the American College of Rehabilitation Medicine (ACRM) reviewed and recommended. [34] Highlights of these guidelines include the following:

Initial measures

Spinal motion restriction (SMR) can be achieved with a backboard, scoop stretcher, vacuum splint, ambulance cot, or other similar devices.

The cervical collar can be discontinued without additional radiographic imaging in an awake, asymptomatic adult trauma patient with (1) a normal neurologic exam, (2) no high-risk injury mechanism, (3) free range of cervical motion, and (4) no neck tenderness. Collar removal is recommended for an adult blunt trauma patient with no neurologic symptoms and a negative helical cervical computed tomography (CT) scan. A negative helical cervical CT scan suffices for collar removal in an adult blunt trauma patient who is obtunded or unevaluable.

Plain radiographs of the cervical and thoracolumbar spine are not recommended in the initial screening of spinal trauma; noncontrast multidetector CT (MDCT) is the initial imaging modality of choice. Magnetic resonance imaging (MRI) is the only modality for evaluating the internal structure of the spinal cord.

Management of injury

Occipital condyle fractures without neural compression or craniocervical misalignment can be managed with a rigid or semirigid cervical orthosis. Treatment of cervical fractures is individualized according to fracture type and patient factors (eg, age). Stable thoracolumbar fractures without neurologic deficits can be treated with adequate pain control and early ambulation without a brace.

Pain management is a priority and should be delivered via a multimodal approach.

Physical and occupational therapy should be initiated within 1 week after injury for patients who are determined to be medically ready.