Canadian C-Spine Rule


Whether or not radiologic imaging is required to clear a C-spine


  • Emergency department
  • Trauma cases
  • GCS 15
  • Stable vital signs
  • >16 years old
  • No acute paralysis
  • No known vertebral disease
  • No previous C-spine surgery


  1. Any high-risk factor which would mandate radiology?
    • Age >64 years
    • Dangerous mechanism
      • fall from elevation >= 3 feet or 5 stairs
      • axial load to head, e.g. diving
      • MVC high speed (>100 km/hr), rollover, ejection
      • motorized recreational vehicles
      • bicycle struck or collision
    • Paresthesias in extremities
  2. Any low-risk factor which allows safe assessment of range of motion?
    • Simple rearend MVC
      • not pushed into oncoming traffic
      • not involving a bus or large truck
      • no rollover
      • not hit by a high-speed vehicle
    • Sitting position in ED
    • Ambulatory at any time
    • Delayed onset of neck pain
    • Absence of midline C-spine tenderness
  3. Able to actively rotate neck?
    • 45 degrees to the left and right


If no to 1, yes to 2, and yes to 3, no radiography needed to clear C-spine


  1. Stiell IG, Clement CM, McKnight RD, Brison R, Schull MJ, Rowe BH, Worthington JR, Eisenhauer MA, Cass D, Greenberg G, MacPhail I, Dreyer J, Lee JS, Bandiera G, Reardon M, Holroyd B, Lesiuk H, Wells GA. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003 Dec 25;349(26):2510-8. PubMed PMID: 14695411.