Clearing the Cervical Spine in Blunt Trauma

Abstract

This chapter will review the current strategies available to clear the cervical spine (C spine) in the blunt trauma patient. Review of recent literature to evaluate the current available physical exam and imaging techniques was completed. Clinical exam in the alert patient without pain or neurologic deficit and full ROM can be used to clear the cervical spine in blunt trauma patients. In the obtunded trauma patient debate exists as to the best method of clearance. Imaging should be completed on all others with blunt trauma and neck pain, neurologic deficit and altered mental status. The presence of a distracting injury and cervical spine (C spine) clearance is controversial. Use of plain radiographs has been replaced with use of computed tomography (CT) scan as the screening tool in adults with blunt trauma. After completion of the CT scan with a negative result, options for further evaluation or collar removal are varied. Computed tomography (CT) scan is the gold standard screening evaluation tool for those adult patients needing imaging of the cervical spine following blunt trauma. CT scan has a high negative predictive value for unstable cervical spine injury. Magnetic resonance imaging may have a limited role for clearance of the cervical spine in the obtunded blunt trauma patient.