‘Clearing’ the cervical spine in the unconscious trauma patient

Abstract

This is a systemic review of the published evidence regarding cervical spine management in unconscious trauma patients. We examine the literature in the following sections: use of plain radiography; use of flexion/extenson views; use of computed tomography; use of magnetic resonance imaging. We also review surveys of practice and current guidelines. In contrast to the conscious trauma patient there have been no large prospective multicentre studies to derive a clinical decision rule for the exclusion of cervical spine injury. This review therefore assesses currently available evidence to reach a logical conclusion regarding the most appropriate imaging strategy to exclude significant injury in the cervical spine, whilst minimising the time that a patient needs to remain immobilised.