Spine clearance protocols vary from institution to institution. A conversant, oriented child without head injury, intoxication or painful distracting injury may be 'clinically cleared' based on a complete, normal neurological examination and palpation of a nontender and fully mobile spinal column. Children with tenderness or examination limitations must undergo radiographic evaluation, as described above. Comatose or sedated children must be maintained in a cervical collar with spine precautions until cleared by negative spine radiographs supplemented by MRI, to rule out ligamentous injury. It should be emphasized that 'clearing' the spine requires knowledge not only of the imaging studies but also of the clinical status of the patient.
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