The guidelines are simple and evidence based

About 600-700 people sustain acute traumatic injuries to the spinal cord in the United Kingdom each year. Previously published data indicate that the injury to the spinal cord remains unrecognised in 4-9% of individuals.1 2 Inadequate management of patients with injury to the spinal cord has the potential to lead to neurological deterioration, additional functional handicaps, and possibly medical litigation. Thousands of patients, however, routinely present to primary care centres every day with injuries to the neck and back. The immediate care and appropriate assessment of patients with spinal injury is a skill that is expected of all doctors. General practitioners and hospital doctors with little or no training and experience of caring for patients with trauma might have to help the victims of a recent accident. They will certainly have to advise patients who complain of spinal pain after injury. This article is written to guide clinicians in these situations.

The evidence base for this subject has improved recently with some large scale studies from North America.3 4 Several consensus guidelines have been published by the National Institute for Clinical Excellence and the British Trauma Society.5 6 Most of the patients in these studies have been treated in secondary care, but …