Clearance Cervical Spine



Ventilated trauma patient

- most will have CT scan

- doesn't exclude ligamentous injury


Hard collar

- will cause neck ulcers if left on indefinitely (occiput and jaw)

- raises the ICP / issue in head injured patient




1.  MRI

- sensitive but difficult especially in unwell, ventilated patient

- patients become more unstable being take to MRI

- ICP tend to rise (problem in head injuries)

- may increase time that cervical collar is left on


2.  Flexion / extension views of unconscious patient

- under fluroscopy

- is this safe in the ventilated patient?

- has been shown to be very safe

- only very occasionally detects unstable injury missed by CT

- however, difficult to defend if patient wakes up with neurology


3.  CT scan alone

- reported incidence of missed unstable C spine injury is 2.5%




Spiteri et al J Trauma Infection and Critical Care 2006

- 839 ventilated trauma patients

- protocol of radiographs, helical CT and dynamic screening

- 87 unstable C spine injuries

- helical CT picked up 85

- dynamic screening picked up 1

- dynamic screening missed one atlanto-occipital dislocation

- a powers ratio on the CT would have detected this

- their conclusion was that helical CT was sufficient


Stelfox et al J Trauma Infection and Critical Care 2007

- 140 patients

- cervical collar removed if MRI or helical CT C0 - T1 normal

- policy changed to CT only

- no report of missed injury

- MRI patients waited longer, more likely to get ulcers, were ventilated longer