If CCSR or NEXUS criteria is met, patient can be cleared clinically
If unable to be cleared by CCSR or NEXUS then imaging is indicated with CT C-spine is indicated
CT recommended over xray
For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%
If negative CT for boney injury may clear spine unless
Patient Altered (see below)
Neurologic abnormalities
CT recommended over xray
For significant injury CT has a sensitivity of 100% while xray has a sensitivity 36%
Patient Altered (see below)
Neurologic abnormalities
EAST (Eastern Association for the Surgery of Trauma) performed systematic review in 2015
Review included 1800 obtunded patients generally defined as GCS<13 with negative CT c-spine using <3mm axial cuts
Of 1800 patients, 176 patients with abnormal MRI
None (or 0/176) had unstable C-spine injury
EAST guideline notes: We conditionally recommend cervical collar removal after a negative high-quality C-spine CT scan result alone
C-spine<unk>  with CT was highly accurate and reliable for identifying clinically significant spine injuries, and had a 100% NPV for identifying unstable injuries. 
10,191 patient multicenter prospective study
Supplement to EAST recommendations
99.9% NPV for clinically significant C-spine injuries
The practice of continuing spine precautions due to concerns about intoxication despite a negative CT scan only result in significantly prolonged immobilization and c-collar wear, with no benefit in identifying additional injuries
Prolonged C-spine immobilization is still at times selectively used in both sober or intoxicated patients based on evaluation, individual threshold and practice
Review included 1800 obtunded patients generally defined as GCS<13 with negative CT c-spine using <3mm axial cuts
Of 1800 patients, 176 patients with abnormal MRI
None (or 0/176) had unstable C-spine injury
EAST guideline notes: We conditionally recommend cervical collar removal after a negative high-quality C-spine CT scan result alone
10,191 patient multicenter prospective study
Supplement to EAST recommendations
99.9% NPV for clinically significant C-spine injuries
The practice of continuing spine precautions due to concerns about intoxication despite a negative CT scan only result in significantly prolonged immobilization and c-collar wear, with no benefit in identifying additional injuries
Cervical spine clearance
Canadian cervical spine rule
Trifascicular Block
Nasal intubation
Advanced airway adjuncts
Thumb spica splint
NEXUS cervical spine rule
Awake intubation