Cervical Spine Clearance in Adult and Pediatric Trauma: A Systematic Review

Cervical spine clearance after trauma is essential for preventing secondary neurologic injury while avoiding unnecessary immobilization and imaging. Advances in computed tomography (CT) and standardized clinical decision rules such as National Emergency X-Radiography Utilization Study and the Canadian C-Spine Rule have changed protocols for adult and pediatric patients.

This systematic review aims to compile current evidence to identify safe, effective, and evidence-based methods for cervical spine clearance.

A PubMed/MEDLINE systematic search was conducted through October 2025 for studies evaluating cervical spine clearance in adult and pediatric trauma patients. Eligible studies analyzed clinical decision tools or imaging modalities (such as physical examination, radiography, CT, magnetic resonance imaging [MRI], ultrasound) and reported on diagnostic accuracy, safety, or workflow outcomes. Data was extracted and narratively synthesized due to methodological heterogeneity.

Thirty-three adult and eleven pediatric studies met the inclusion criteria. In adults, multidetector CT with multiplanar reconstructions achieved 98-100% sensitivity and >99% negative predictive value for clinically significant or unstable injury, supporting collar removal after a normal CT even in obtunded or intoxicated patients. MRI detected additional findings in 0.4-3% of cases, rarely changing management. In children, structured clinical protocols combining physical examination and plain radiography safely reduced CT use by up to 70%, with MRI reserved for persistent symptoms or ligamentous concerns.

Modern multidetector CT is the gold standard for adult cervical spine clearance, while pediatric management favors radiation-sparing, protocol-based approaches. Evidence supports tiered, algorithmic strategies emphasizing clinical assessment, selective imaging, and early collar removal to optimize safety and efficiency in trauma care.