The Initial Assessment and Management of Cervical Spine Injuries: A Comprehensive Review

Cervical spine injuries (CSIs) are the most frequently encountered spinal injuries resulting from blunt trauma, owing to the cervical region's anatomical vulnerability and high mobility. Early recognition and spinal motion restriction (SMR) are essential in preventing secondary spinal cord injury (SCI), particularly in pre-hospital settings. This literature review explores the comprehensive management of suspected CSIs from the pre-hospital setting to definitive care in the hospital. It highlights the importance of clinical suspicion based on the mechanism of injury, appropriate application of SMR, and the role of imaging modalities such as CT and MRI in diagnosis. Clinical decision tools, including the National Emergency X-Radiography Utilization Study (NEXUS) criteria and Canadian C-Spine Rules (CCR), are discussed in relation to reducing unnecessary imaging while maintaining patient safety. The review also addresses current debates around cervical collar use, the necessity of structured neurological assessments, and the importance of multidisciplinary collaboration. Classification systems such as the Subaxial Cervical Spine Injury Classification System (SLIC) and AO Spine Trauma Classification are evaluated for their role in guiding treatment decisions. Effective care for CSI requires timely intervention, accurate imaging, and coordination among emergency, radiology, intensive care, and spinal surgical teams to minimise neurological complications and improve outcomes.