Introduction All trauma patients have a cervical spine injury until proven otherwise Cervical spine clearance defined as confirming the absence of cervical spine injury important to clear cervical spine and remove collar in an efficient manner login to view 1 more bullet cervical clearance can be performed with login to view 2 more bullets Missed cervical spine injuries may lead to permanent disability careful clinical and radiographic evaluation is paramount login to view 4 more bullets cervical spine injury necessitates careful examination of entire spine login to view 1 more bullet History Details of accident energy of accident login to view 6 more bullets mechanism of accident login to view 2 more bullets condition of patient at scene of accident login to view 3 more bullets Identify associated conditions and comorbidities ankylosing spondylitis (AS) diffuse idiopathic skeletal hyperostosis (DISH) previous cervical spine fusion (congenital or acquired) connective tissue disorders leading to ligamentous laxity Physical Exam Useful for detecting major injuries Primary survey airway breathing circulation visual and manual inspection of entire spine should be performed login to view 2 more bullets Secondary survey cervical spine exam login to view 8 more bullets Clinical Cervical Clearance Removal of cervical collar WITHOUT radiographic studies allowed if: patient is awake, alert, and not intoxicated AND has no neck pain, tenderness, or neurologic deficits AND has no distracting injuries Utilizing updated clinical practice guidelines and Nexus criteria for pediatric C-spine clearance less radiation exposure with reduced CT scans for C-spine clearance Radiographic Cervical Clearance Indications for obtaining radiographic clearance intoxicated patients OR patients with altered mental status OR neck pain or tenderness present OR distracting injury present Methods radiographs login to view 4 more bullets CT scan login to view 1 more bullet Treatment Nonoperative cervical collar login to view 2 more bullets early active range of motion login to view 3 more bullets Complications Delayed clearance associated with increased complication rate including increased risk of aspiration inhibition of respiratory function decubitus ulcers in occipital and submandibular areas possible increase in intracranial pressure Mortality increased in geriatric patients