ABSTRACT
Immobilization of the cervical spine at the scene of the injury is an important part of the early care of pediatric trauma patients. Exclusion of injury and discontinuation of immobilization (cervical spine clearance), while relatively routine in the awake, asymptomatic patient, can be very challenging in small children or in patients with a decreased level of consciousness. Expeditious clearance of the cervical spine is important to avoid the possible complications of spinal immobilization, including decubiti and aspiration. While a pediatric neurosurgeon or orthopedist is involved early for a patient with closed head injury or obvious neurological deficit, a pediatric surgeon, general trauma surgeon, or emergency room physician performs the majority of cervical spine assessments on trauma patients. Clinical assessment is the most important aspect of cervical spine evaluation, but a variety of imaging modalities, including plain radiography, computed tomography (CT), and magnetic resonance imaging (MRI) can assist the clinician with decisions about discontinuation of immobilization. The judicious use of these modalities attempts to discover all injuries while avoiding the overuse of radiologic procedures and prolonged immobilization.
