Cervical spine clearance in obtunded blunt trauma patients: a prospective study

J Trauma. 2010 Mar;68(3):576-82. doi: 10.1097/TA.0b013e3181cf7e55.


Background: : An acceptable algorithm for clearance of the cervical spine (C-spine) in the obtunded trauma patient remains controversial. Undetected C-spine injuries of an unstable nature can have devastating consequences. This has led to reluctance toward C-spine clearance in these patients.

Objective: : To objectify the accuracy of computed tomography (CT) scanning compared with dynamic radiographs within a well established C-spine clearance protocol in obtunded trauma patients at a level I trauma center.

Methods: : This was a prospective study of consecutive blunt trauma patients (18 years or older) admitted to a single institution between December 2004 and April 2008. To be eligible for study inclusion, patients must have undergone both a CT scan and dynamic plain radiographs of their C-spine as a part of their clearance process.

Results: : Among 402 patients, there was one injury missed on CT but detected by dynamic radiographs. This resulted in a percentage of missed injury of 0.25%. Subsequent independent review of the CT scan revealed that in fact pathologic changes were present on the scan indicative of the injury.

Conclusions: : Our results indicate that CT of the C-spine is highly sensitive in detecting the vast majority (99.75%) of clinically significant C-spine injuries. We recommend that CT be used as the sole modality to radiographically clear the C-spine in obtunded trauma patients and do not support the use of flexion-extension radiographs as an ancillary diagnostic method.

Publication types

  • Controlled Clinical Trial

MeSH terms

  • Adult
  • Cervical Vertebrae / injuries*
  • Consciousness Disorders / complications*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Posture
  • Predictive Value of Tests
  • Prospective Studies
  • Range of Motion, Articular
  • Reproducibility of Results
  • Spinal Injuries / diagnostic imaging*
  • Spinal Injuries / psychology*
  • Spinal Injuries / therapy
  • Tomography, X-Ray Computed*
  • Wounds, Nonpenetrating / diagnostic imaging*
  • Young Adult