The Asymptomatic Patient

The use of clinical criteria to "clear" the cervical spine and avoid unnecessary radiographs in selected trauma patients has been suggested by authors of several studies.1011 and12 The criteria examined were a combination of relevant historical and physical examination features. Patients meeting the criteria did not have significant cervical spine injury requiring radiographs. 13 The criteria that excluded cervical spine injury in these blunt trauma patients were:

1. Alertness, absence of intoxication

2. Absence of neck pain

3. Absence of neck tenderness

4. Absence of painful distracting injuries

5. Absence of sensory or motor deficit

Trauma patients who do not meet all of these criteria should have plain radiographs to evaluate the cervical spine. These should include lateral, anteroposterior, and odontoid views. If these views are normal and the patient is cooperative and has no neurologic signs or symptoms, active range of motion and/or flexion-extension views can be used to further evaluate the cervical spine.

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