Early Management of Suspected Cervical Spine Injury: A Real-World Insight From a London Major Trauma Centre

Abstract

Cervical spine trauma represents a critical subset of blunt injuries, accounting for 2-3% of cases and over half of spinal cord injuries. This retrospective narrative review from the Royal London Hospital analyses the initial management of such injuries, emphasising protocol-led care involving spinal protection (British Orthopaedic Association Standards for Trauma (BOAST), Advanced Trauma Life Support (ATLS), National Institute for Health and Care Excellence (NICE)), clinical assessments (Glasgow Coma Scale (GCS), American Spinal Injury Association (ASIA)), and imaging (multidetector computed tomography (MDCT), magnetic resonance imaging (MRI)). Multidisciplinary involvement, particularly anaesthetics, intensivists, and spinal surgeons, was key to optimising outcomes. MDCT showed excellent diagnostic accuracy, and early surgical decompression within 24 hours, as supported by the Surgical Treatment of Acute Spinal Cord Injury Study (STASCIS), correlated with better neurological recovery. Steroids and other pharmaceuticals have either ceased use or are currently avoided due to adverse effects. Overall, timely imaging, coordinated care, and evidence-based interventions are central to effective cervical spine trauma management.