Spine Clearance (in progress)

Definition of Spine Clearance 

A cervical spine is determined to be stable is: 

  • No posterior midline C tenderness 
  • No eviednec eintox 
  • No FND 
  • No  

Outcome of Spine Clearance 

  • Spine without injury 
  • Spine with injury 
    • Stable 
    • Unstable 

Missed injuries .07%-26% according to Davis et al 1993 

System to review the CT Scan 

  • Soft Tissue 
    • Alar Apical TL  
    • PLL 
    • Fat planes – black on soft tissue window 
      • Between IS regions 
  • Bone 

MRI Indication  

  • Neuro deterioaiton 
  • Unexplained neuo 
  • Presurgical neural imaging (disc herniation, bilateral jumped facet) 
  • Disc herniation 
  • Occult Fracture (ank spond) 
  • Evaluation Soft Tissue injury (TL, PLC) 

1.) Awake patient 

2.) Mentation Impaired – temporary 

3.) Mentation impaired – permanent 

Alert Patient 

  • No tenderness 
  • No unexplained neuro 
  • 3 views of C spine negative 
  • NB – no neck pain, no tenderness, painfree ROM = clar clinically no need fot XRs 

Good to bad prognosis 




Anterior – bad prognosis because motor involvement 

Peripheral vs Central Nerve Exam 

**if cognitive impairment will last >4 days then try to clear  

  • Clear radiographically via CT or the MRI (the literature is conflicted on this, but at SBK they like CT scan) 

MRI is key to see a 

  •  TL ligament or a posterior facet (usually will have other signs) 
  • Epidural hematoma can usually see on soft tissue window 
  • Disc herniation can usually see on a soft tissue window 

MRI can be overly sensitive – what is overly unstable