Complications of immobilisation
Skin ulceration
Access - Central venous, airway

Clear spine within 48h

GCS 15, not confused
Absence sedatives/intoxicants
No spinal tenderness, deformity or neurological deficit
No distracting injury

XR alone misses 10% unstable injuries
CT and XR miss 0.5%
10% # incidence in polytrauma

GCS 15 but don’t meet above clinical preconditions:
Lateral, AP and odontoid peg views of cervical spine
AP and lateral T and L spine if appropriate mechanism of injury

GCS 12-14
Lateral and AP C-spine
CT C1 to C3
Add C7/T1 if this cannot be visualised on the first lateral film
Add whole C-spine if any abnormality seen on X-ray or CT
Lateral and AP T and L spine

GCS <12
CT base of skull to T4

Multiple injuries or cardio-respiratory instability:
CT whole spine (will want thoracic and abdo CT anyway for other injuries)

Management before clearance
Soft semi-rigid collar – Aspen, Philadelphia
Standard firm hospital mattress initially
Take care pressure areas – pressure relieving mattress
If fixed with halo or surgical then normal bed

Once radiologically cleared:
Careful handling
Head up tilt
Reapply collar when awaking from sedation

Very sensitive for ligamentous injury but poor specificity
Practically challenging
Therefore rarely done