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Clinical Clearance of Cervical Spine Injury
Karim Brohi, 7:4, April 2002

Cervical spine assessment

Spinal immobilisation is a priority in multiple trauma, spinal clearance is not.

The spine should be assessed and cleared when appropriate, given the injury characteristics and physiological state.

Imaging the spine does not take precedence over life-saving diagnostic and therapeutic procedures.

Initial Assessment of Spinal Trauma

Spinal Stabilization
Clinical Clearance
Conscious Patients
Unconscious Patients
Thoracic & Lumbar Spine
Paediatric Spinal Injury

Clinical clearance of Cervical Spine Injury

Numerous large prospective studies have described the large cost and low yield of the indiscriminate use of cervical spine radiology in trauma patients. Although there are case reports of bony or ligamentous injuries in asymptomatic patients, no asymptomatic patient in the literature has had an unstable cervical spine fracture or suffered neurological deterioration due to the injury. There is no conclusive evidence in the literature that supports clinical clearance of the spine in the prehospital environment. There is enough variation between prehospital and in-hospital assessments to recommend that prehospital removal of spinal immobilisation be avoided. Mechanism of injury alone does not determine the need for radiological investigation.

The cervical spine may be cleared clinically if the following preconditions are met:

  • Fully alert and orientated
  • No head injury
  • No drugs or alcohol
  • No neck pain
  • No abnormal neurology
  • No significant other 'distracting' injury (another injury which may 'distract' the patient from complaining about a possible spinal injury).

Provided these preconditions are met, the neck may then be examined. If there is no bruising or deformity, no tenderness and a pain free range of active movements, the cervical spine can be cleared. Radiographic studies of the cervical spine are not indicated.

Conscious, symptomatic patients



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Conscious, symptomatic patients (7:4) April 2002