Cervical spine clearance in adult trauma patients: What you need to know

Cervical spine clearance is a fundamental component of the trauma evaluation. These injuries can be stable and asymptomatic or lead to devastating outcomes including permanent paralysis. The ideal process for clearance of the cervical spine has been a longstanding challenge. This is particularly relevant for obtunded patients, in whom the need for imaging should be balanced against the potential complication burden of extended collar use. Prolonged cervical immobilization is associated with higher risks of elevated intracranial pressure, aspiration, respiratory compromise, thromboembolic events, pressure ulcers, longer intensive care stays, and higher health care-related costs. This review will provide a pragmatic set of recommendations for cervical spine clearance, summarizing the existing data. In alert, examinable patients without neurological deficits, clinical assessment using validated decision-making tools allows safe clearance without further radiographic studies. When clinical reliability is compromised, due to altered mental status, intoxication, or distracting injuries, multidetector computed tomography (CT) has emerged as the primary screening imaging modality, offering high sensitivity for clinically significant injuries. In obtunded patients, an adequate and normal high-quality CT supports collar removal without the need for adjunctive imaging. The use of magnetic resonance imaging should be reserved for patients with neurological deficits or CT findings suggestive of soft tissue or ligamentous injury. A timely, evidence-informed, and standardized approach to cervical spine clearance is essential to ensure patient safety, reduce preventable harm, and support efficient trauma workflows.