====== Cervical spine clearance ======

Clearing the [[cervical spine]] is the process by which medical professionals determine whether [[cervical spine injury]] exist. This process can take place in the [[emergency department]] or take place in the field by appropriately trained EMS personnel. 

The following is based on the [[NEXUS Criteria for C-Spine Imaging]].

There are other clinical criteria in common use, such as the [[Canadian Cervical Spine Rule]].

Excluding a cervical spinal injury requires clinical judgement and training.

Under the NEXUS guidelines, when an acute blunt force injury is present, a cervical spine is deemed to not need radiological imaging if all the following criteria are met:

There is no posterior midline cervical tenderness.

There is no evidence of [[intoxication]].

The patient is alert and oriented to person, place, time, and event.

There is no [[focal neurological deficit]] (see focal neurological signs).

There are no painful distracting injuries (e.g., long bone fracture)

If the patient does not meet all the above criteria then they require a three view [[Cervical Spine X Ray]]  series, adding a swimmer's view if the lateral doesn't include the C7/T1 interface. In those with degenerative disease of the cervical spine, a plain film series is often inadequate to assess for injury. Plain radiographs, even when technically optimal, my fail to reveal significant injury. If there is clinical suspicion, a Computerized Tomography (CT Scan) may be needed to rule out a fracture, and flexion-extension radiographs or Magnetic Resonance Imaging to exclude a ligament injury.

If the patient is obtunded, i.e. has a head injury with altered sensorium, is intoxicated, or has been given potent analgesics, the cervical spine must remain immobilized until a clinical examination becomes possible.

If the patient is not expected to be clinically evaluable within 48–72 hours because of severe head or multiple injuries, they should remain immobilized until a time when such an examination is possible. A 64-slice CT with reconstructions does not entirely rule out ligamentous injury leading to instability, but is a practical means of identifying the majority of C-spine injuries in obtunded patients. MR C-spine suffers from frequent false-positives, limiting its usefulness. In these cases, a consultation with a Spine Surgery specialist is prudent.

The indication for MR spine is a focal neurological deficit. Another indication for MR of the cervical spine is persistent mid-line neck pain or tenderness despite a normal CT in the awake patient.
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see [[Pediatric Cervical Spine Clearance]]


===== References =====