Clearing the cervical spine is the process by which medical professionals determine whether cervical spine injuries exist, mainly regarding cervical fracture. It is generally performed in cases of major trauma. This process can take place in the emergency department or in the field by appropriately trained EMS personnel.

If the patient is obtunded, i.e. has a head injury with altered sensorium, is intoxicated, or has been given potent analgesics, the cervical spine must remain immobilized until a clinical examination becomes possible.

Neurosurgeons or orthopaedic surgeons manage any detected injury. Today, most large centers have spine surgery specialists, that have trained in this field after their orthopedic or neurosurgical residency.

A medical history and physical examination can be sufficient in clearing the cervical spine. Notable clinical prediction rules to determine which patients need medical imaging are the Canadian C-spine rule and the National Emergency X-Radiography Utilization Study (NEXUS).

The following is based on the NEXUS (National Emergency X-Radiography Utilization Study) criteria.

Excluding a cervical spinal injury requires clinical judgement and training.

Under the NEXUS guidelines, when an acute blunt force injury is present, a cervical spine is deemed to not need radiological imaging if all the following criteria are met:

Magnetic resonance imaging may be useful if it is necessary to exclude a ligament injury. The indication for MR spine is a focal neurological deficit. Another indication for MR of the cervical spine is persistent mid-line neck pain or tenderness despite a normal CT in the awake patient.