Cervical spine clearance in trauma patients

The most appropriate cervical spine clearance protocol for trauma patients remains a matter of debate. While the adoption of multislice CT as first-line imaging in suspected cervical spine trauma is supported by an abundance of evidence, the lack of CT scanning availability in rural or remote areas continues to necessitate the use of three or fiveview plain radiography, which has consistently been reported as inefficient for the detection of fractures. Similarly, controversy exists in regard to the efficiency and appropriateness of CT imaging to clear the cervical spine in obtunded patients who are unable to be assessed clinically, and in alert and neurologically intact patients with persisting neck pain or midline cervical tenderness. In an area of medicine where randomised controlled trials may not be appropriate, the use of large multicentre prospective cohort studies aimed at ascertaining the optimal imaging strategies for cervical spine clearance are essential in providing definitive solutions to these current clinical controversies.