'Clearing' Cervical Spine Injuries in Polytrauma Patients: Is It Really Safe to Remove the Collar?

Abstract

Polytrauma patients are at increased risk for occult cervical spine injuries. Those unable to provide clinical dues to injury either remain in hard collars until they are able to cooperate with the physical examination or are deemed "clear of cervical injury" if the emergency room screening radiographs are without obvious bony abnormality. Cervical immobilization for a lengthy period of time is not without morbidity. Missed ligamentous injuries can lead to cervical instability, which in turn can result in permanent neurologic sequelae. This article reviews the current methodologies to "clear the cervical spine" and highlights the inadequacies.

Occurrence and Significance of Odontoid Lateral Mass Interspace Asymmetry in Trauma Patients

“…However, there is still ongoing debate on the characteristic radiologic signs and the significance of OLMI asymmetry (normal variant vs. pathologic finding) [38][39][40] related to the occipitoatlantoaxial traumatic lesions [41]. In fact, the plethora of guidance [42][43][44][45][46][47] reflects incomplete and inadequate data and further contributes to practice variance [20,[48][49][50]. Moreover, many patients undergo technically inadequate studies with inaccurate interpretations…”