C-Spine Clearance

Minimize unnecessary imaging while safely clearing cervical spine motion restriction.

AHS Official

Updated: 05/04/2025

C-spineSMRCTNSGY

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✅Evaluable Patient — Clinical Clearance

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ALL required to be evaluable:

Age <65
GCS 15, not intoxicated
No language barrier
No significant distracting injury

Normal exam (ALL required to remove collar):

Normal active ROM
No midline cervical tenderness
No focal neurologic deficit
No spinal deformity

🔴CT Required If Criteria Not Met

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No fracture, tender

Spine consult. Neck pain ≠ emergent MRI. Defer to spine.

Acute fracture

Continue SMR. IP consult + call NSGY. Most C-spine fx → also get CTA neck (BCVI CPG).

Neuro deficit

STAT MRI. IP consult + call NSGY attending. Notify Trauma Attending.

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No SMR for penetrating trauma unless directed by Trauma Attending or NSGY.

🔬Decision Rule Calculators — NEXUS & Canadian C-Spine Rule

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These validated decision tools may help guide imaging decisions. General educational reference — use in conjunction with the AHS C-Spine Clearance CPG (05/04/2025), not as a replacement for it.

Check any criterion that is present. All absent = low risk.

Midline posterior cervical tenderness

Focal neurologic deficit

Altered level of alertness

Intoxication

Painful distracting injury

Select criteria above

Step through the 3 Canadian C-Spine Rule criteria.

Step 1 — High-risk? (any = imaging)

Age ≥65 years

Dangerous mechanism

Fall ≥3ft/5 stairs, axial load, MVC ≥60mph, rollover, ejection, motorized recreational, bicycle

Paresthesias in extremities

Step 2 — Low-risk? (any = proceed to Step 3)

Simple rear-end MVC

Sitting in ED / Ambulatory at any time / Delayed neck pain / No midline tenderness

Step 3 — Can rotate 45° left AND right?

Yes No

Complete all steps above

Status: AHS Official Protocol
Source: C_Spine_Clearance_2025.docx
Last reviewed / updated: 05/04/2025