ABSTRACT
Clinical Evaluation As with any trauma patient, individuals presenting with a suspected neck injury should have an initial evaluation according to advanced trauma life support guidelines.(3-5) Once the patient’s airway, breathing, and circulatory status are stable and any lifethreatening conditions stabilized, secondary survey of the spine should be performed. During initial assessment, patients suspected of having any spine injury should be log-rolled carefully and the entire spine, from occiput to sacrum, palpated for tenderness or step-off hematoma, ecchymosis, or skin breaks should be noted. A careful neurologic examination including mental status, cranial nerves (CNs), detailed motor and sensory evaluation, and deep tendon reflexes should be documented. Finally, a rectal examination assessing rectal tone and volition and BC reflex should be performed and documented by a member of the spinal surgery team. The American Spinal Injury Association (ASIA) worksheet seen in Figure 6.7a and b is a comprehensive tool for documentation of the neurological examination.
