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Canadian C-Spine Rule

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Other Names

  • Canadian C-Spine Rule
  • Canadian Cervical Spine Rule


  • Decision making tool for radiographic evaluation of the cervical spine following trauma
  • Generally speaking, the application of this tool requires a patient to be clinically stable with a GCS of 15


Canadian C-spine rules[1]

1) Any high risk factors which mandate radiography?

  • Age greater than 65
  • Dangerous Mechanism
    • Fall from elevation >3 feet or 5 stairs
    • Axial load to head
    • MVC speed >100 km/hr, rollover or ejection
    • Motorized Recreational vehicles
    • Bicycle struck or collision
  • Parasthesias in extremities

2) Any low row risk factor which allows safe assessment of range of motion?

  • Simple rear-end motor vehicle collision (MVC)
    • Excludes: Pushed into oncoming traffic, hit by bus or large truck, rollover, hit by high speed vehicle
  • Sitting position in emergency department
  • ambulatory at any time
  • delayed onset of neck pain (not immediate onset)
  • absence of midline C spine tenderness

3) Able to actively rotate neck?

  • 45° left and right

4) Imaging Indicated

  • Yes to question 1 (high risk features)
  • No to question 2 (low risk features)
  • Inability to range neck (unstable)



  • Stiell et al[2]
    • Sensitivity: 99.4
    • Specificity: 45.1

See Also


  1. Image courtesy of canadianem.org, "Canadian C-spine Rule Mnemonic"
  2. Stiell IG et al. The Candian C-Spine Rule versus the NEXUS Low-Risk Criteria in patients with trauma. N Engl J Med 2003;349:2510-8.
Created by:
John Kiel on 23 July 2019 00:35:04
Last edited:
25 March 2023 07:22:04