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.

Today, most large centers have spine surgery specialists, that have trained in this field after their orthopedic or neurosurgical residency.

Another indication for MR of the cervical spine is persistent mid-line neck pain or tenderness despite a normal CT in the awake patient.

[10] CT scan or X-ray images are evaluated for the presence or absence of directly visible fractures.

In addition, indirect signs of injury by the vertebral column are incongruities of the vertebral lines,[11] and/or increased thickness of the prevertebral space:[12] If the patient is not expected to be clinically evaluable within 48–72 hours because of severe head or multiple injuries, they should remain immobilized until a time when such an examination is possible.